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General NPI Number Information
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NPI Number | 1851095293
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Entity Type | Individual
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Provider Name | JENNIFER PETERSEN LMSW
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Gender | Female
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Dates
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Enumeration Date | 03/29/2023
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Last Update Date | 03/29/2023
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Provider Practice Location Address
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Address Line | 442 5TH AVE # 1033
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City | NEW YORK
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State | NY
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Zip | 10018-2794
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Country | US
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Telephone | 203-364-4731
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Fax |
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Provider Business Mailing Address
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Address Line | 913 KEN ST
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City | AUSTIN
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State | TX
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Zip | 78758-5117
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Country | US
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Telephone | 281-772-2054
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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 | 089122
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License Number State | NY
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