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General NPI Number Information
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NPI Number | 1245531508
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Entity Type | Individual
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Provider Name | MERISSA NICOLE JENNINGS LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/03/2010
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Last Update Date | 03/13/2017
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Provider Practice Location Address
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Address Line | 20 GILBERT AVE STE 101
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City | SMITHTOWN
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State | NY
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Zip | 11787-5312
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Country | US
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Telephone | 516-852-0248
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Fax | 631-780-6349
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Provider Business Mailing Address
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Address Line | 7 ENFIELD LN
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City | HAUPPAUGE
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State | NY
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Zip | 11788-3309
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Country | US
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Telephone | 516-852-0248
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Fax | 631-780-6349
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 082183-1
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License Number State | NY
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