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General NPI Number Information
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NPI Number | 1609380435
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Entity Type | Organization
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Legal Business Name | JENTEX TRAINING & CONSULTING
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Dates
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Enumeration Date | 12/01/2017
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Last Update Date | 12/01/2017
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Provider Practice Location Address
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Address Line | 159 TWIN LAWNS AVE
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City | BRENTWOOD
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State | NY
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Zip | 11717-6019
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Country | US
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Telephone | 631-231-4704
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Fax | 631-231-4704
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Provider Business Mailing Address
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Address Line | PO BOX 430
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City | CENTRAL ISLIP
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State | NY
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Zip | 11722-0430
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Country | US
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Telephone | 631-231-4704
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Fax | 631-231-4704
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Authorized Official
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Title or Position | CEO
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Name | DAWN SHEDRICK
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Credential | LCSW-R
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Telephone | 631-231-4704
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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 | 076384
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License Number State | NY
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