MEDICARE: JENNIFER R MORGENSTERN LCDC III

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	LCDCIII.021249	OH

General Provider Information

NPI Number	:	1467958876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER R MORGENSTERN LCDC III

Provider Business Mailing Address
First Line	:	124 DENNIS DR
Second Line	:
City	:	CORTLAND
State	:	OH
Zip	:	44410-1134
Country	:	US
Telephone Number	:	330-219-4453
Fax Number	:

Provider Business Practice Location Address
First Line	:	3622 BELMONT AVE STE 21
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44505-1444
Country	:	US
Telephone Number	:	234-719-1885
Fax Number	:

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

Provider Enumeration Date	:	04/04/2018
Last Update Date	:	04/04/2018

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