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General NPI Number Information
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NPI Number | 1386509933
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Entity Type | Individual
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Provider Name | JENNIFER LYNN NELSON LMSW
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Gender | Female
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Dates
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Enumeration Date | 12/17/2025
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Last Update Date | 12/17/2025
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Provider Practice Location Address
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Address Line | 1050 HALLOCK AVE STE 3
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City | PORT JEFFERSON STATION
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State | NY
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Zip | 11776-1214
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Country | US
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Telephone | 631-403-2188
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Fax |
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Provider Business Mailing Address
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Address Line | 12 COTTAGE DR
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City | FARMINGVILLE
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State | NY
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Zip | 11738-2262
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Country | US
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Telephone |
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 094393
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License Number State | NY
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