=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508237017
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEANNIE M FINO LMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/09/2015
-----------------------------------------------------
Last Update Date | 07/27/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2127 CROMPOND RD STE 202B
-----------------------------------------------------
City | CORTLANDT MANOR
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10567-4334
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-357-5921
-----------------------------------------------------
Fax | 914-302-3088
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18 ADELA CT
-----------------------------------------------------
City | YORKTOWN HEIGHTS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10598-2505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-357-5921
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 001377-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------