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General NPI Number Information
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NPI Number | 1811380397
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Entity Type | Individual
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Provider Name | JESSICA TANNACORE LMSW, CASAC-T
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Gender | Female
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Dates
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Enumeration Date | 03/09/2015
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Last Update Date | 06/29/2015
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Provider Practice Location Address
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Address Line | 950 S OYSTER BAY RD ATTN: FORENSIC ACT TEAM
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City | HICKSVILLE
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State | NY
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Zip | 11801-3510
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Country | US
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Telephone | 516-822-6111
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Fax | 516-396-2791
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Provider Business Mailing Address
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Address Line | 367 N WELLWOOD AVE
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City | LINDENHURST
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State | NY
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Zip | 11757-3341
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Country | US
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Telephone | 631-592-8846
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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 | 094437-1
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License Number State | NY
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