MEDICARE: MS. JENNA MARIE CATALO LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	112980	NY

General Provider Information

NPI Number	:	1013652908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNA MARIE CATALO LMSW

Provider Business Mailing Address
First Line	:	51 OLDERT DR
Second Line	:
City	:	PEARL RIVER
State	:	NY
Zip	:	10965-2928
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	51 OLDERT DR
Second Line	:
City	:	PEARL RIVER
State	:	NY
Zip	:	10965-2928
Country	:	US
Telephone Number	:	845-825-9777
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2022
Last Update Date	:	10/18/2023

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