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General NPI Number Information
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NPI Number | 1447749221
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Entity Type | Individual
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Provider Name | JENAI ROSSOW LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/07/2018
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Last Update Date | 11/03/2020
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Provider Practice Location Address
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Address Line | 222 S ALBANY ST STE 1
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City | ITHACA
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State | NY
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Zip | 14850-5480
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Country | US
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Telephone | 607-229-2529
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Fax |
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Provider Business Mailing Address
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Address Line | 3 BROOKSIDE DR
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City | DRYDEN
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State | NY
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Zip | 13053-9528
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Country | US
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Telephone | 607-229-2529
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 086225
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License Number State | NY
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