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General NPI Number Information
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NPI Number | 1174106298
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Entity Type | Individual
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Provider Name | THERESA ANN JENKINS
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Gender | Female
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Dates
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Enumeration Date | 05/05/2021
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Last Update Date | 05/05/2021
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Provider Practice Location Address
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Address Line | 101 MERMAN DR
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City | DE WITT
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State | NY
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Zip | 13214-1160
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Country | US
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Telephone | 315-925-7310
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Fax |
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Provider Business Mailing Address
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Address Line | 101 MERMAN DR
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City | DE WITT
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State | NY
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Zip | 13214-1160
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Country | US
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Telephone | 131-574-1061
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 00178301
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License Number State | NY
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