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General NPI Number Information
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NPI Number | 1215147996
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Entity Type | Individual
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Provider Name | JENNIFER HUMPHREY LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 07/08/2008
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Provider Practice Location Address
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Address Line | 225 WEST 12TH ST. STE 1B
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City | NEW YORK
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State | NY
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Zip | 10011
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Country | US
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Telephone | 212-255-2216
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Fax |
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Provider Business Mailing Address
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Address Line | 345 W 12TH ST 3
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City | NEW YORK
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State | NY
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Zip | 10014-1702
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Country | US
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Telephone | 212-255-9093
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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 | 102L00000X
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Taxonomy Name | Psychoanalyst
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License Number | RO40927
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | RO40927
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License Number State | NY
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