=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811763972
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JMW THERAPY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2023
-----------------------------------------------------
Last Update Date | 11/29/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16 E 79TH ST STE 44
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10075-0150
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-239-3707
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11 DEER RIDGE RD
-----------------------------------------------------
City | AVON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06001-2882
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-239-3707
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. JENNIFER MCPHEE
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 314-239-3707
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------