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General NPI Number Information
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NPI Number | 1164198271
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Entity Type | Organization
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Legal Business Name | JENNY MAENPAA LICENSED CLINICAL SOCIAL WORKER PLLC
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Dates
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Enumeration Date | 08/18/2021
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 1115 BROADWAY FL 12
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City | NEW YORK
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State | NY
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Zip | 10010-3452
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Country | US
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Telephone | 646-600-8375
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Fax |
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Provider Business Mailing Address
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Address Line | 116 W 23RD ST FL 5
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City | NEW YORK
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State | NY
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Zip | 10011-2599
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Country | US
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Telephone | 646-600-8375
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JENNY MAENPAA
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Credential | LCSW
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Telephone | 508-237-4117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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