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NPI Code Detail

MEDICARE: DR. JENNIFER MCINTOSH PHD, APRN, PMHNP-BC

MEDICARE: DR. JENNIFER MCINTOSH PHD, APRN, PMHNP-BC
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
1363LP0808XPsychiatric/Mental Health Nurse PractitionerF406685-01NY
2363LP0808XPsychiatric/Mental Health Nurse Practitioner1462CT

General Provider Information

NPI Number : 1023813466
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JENNIFER MCINTOSH PHD, APRN, PMHNP-BC
Provider Business Mailing Address
First Line : 437 WADING RIVER RD
Second Line :
City : MANORVILLE
State : NY
Zip : 11949-3446
Country : US
Telephone Number : 631-882-2432
Fax Number :
Provider Business Practice Location Address
First Line : 790 PARK AVE
Second Line :
City : HUNTINGTON
State : NY
Zip : 11743-4516
Country : US
Telephone Number : 631-427-4001
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/18/2025
Last Update Date : 05/28/2026

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