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General NPI Number Information
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NPI Number | 1609326206
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Entity Type | Organization
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Legal Business Name | JENNIFER KELSCH LICENSED CLINICAL SOCIAL WORKER PC
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Dates
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Enumeration Date | 10/06/2016
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Last Update Date | 10/06/2016
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Provider Practice Location Address
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Address Line | 991 MAIN ST SUITE 201
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City | HOLBROOK
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State | NY
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Zip | 11741-1608
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Country | US
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Telephone | 631-875-3549
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Fax | 631-588-8900
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Provider Business Mailing Address
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Address Line | 991 MAIN ST
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City | HOLBROOK
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State | NY
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Zip | 11741-1608
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Country | US
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Telephone | 631-875-3549
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Fax | 631-588-8900
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER
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Name | MS. JENNIFER LYNN KELSCH
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Credential | LCSW-R
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Telephone | 631-875-3549
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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 | 077692
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License Number State | NY
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