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General NPI Number Information
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NPI Number | 1811534852
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Entity Type | Individual
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Provider Name | JENNIFER LYNN DITROCCHIO
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Gender | Female
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Dates
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Enumeration Date | 12/10/2019
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Last Update Date | 09/24/2024
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Provider Practice Location Address
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Address Line | 205 SOUTH AVE
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City | POUGHKEEPSIE
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State | NY
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Zip | 12601-4818
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Country | US
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Telephone | 845-554-1365
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Fax |
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Provider Business Mailing Address
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Address Line | 22 LAKE ONIAD DR
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City | WAPPINGERS FALLS
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State | NY
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Zip | 12590-3854
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Country | US
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Telephone | 845-797-9890
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 011489
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License Number State | NY
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