MEDICARE: AARON S. JENKINS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	101YP1600X	Pastoral Counselor
3	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1336541127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AARON S. JENKINS

Provider Business Mailing Address
First Line	:	29 W LAKELAND ST
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-2623
Country	:	US
Telephone Number	:	917-217-3551
Fax Number	:	631-254-4860

Provider Business Practice Location Address
First Line	:	29 W LAKELAND ST
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-2623
Country	:	US
Telephone Number	:	917-217-3551
Fax Number	:	631-254-4860

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

Provider Enumeration Date	:	09/23/2014
Last Update Date	:	09/23/2014

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