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NPI Code Detail

MEDICARE: MS. JENNIFER STACY DENEERGAARD LCSW

MEDICARE: MS. JENNIFER STACY DENEERGAARD LCSW
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
1104100000XSocial Worker077746-1NY
21041C0700XClinical Social Worker093823-01NY

General Provider Information

NPI Number : 1477806370
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JENNIFER STACY DENEERGAARD LCSW
Provider Business Mailing Address
First Line : 60 WALNUT AVE
Second Line :
City : EAST NORWICH
State : NY
Zip : 11732-1416
Country : US
Telephone Number : 516-922-6688
Fax Number : 516-922-6126
Provider Business Practice Location Address
First Line : 60 WALNUT AVE
Second Line :
City : EAST NORWICH
State : NY
Zip : 11732-1416
Country : US
Telephone Number : 516-922-6688
Fax Number : 516-922-6126
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/17/2012
Last Update Date : 08/28/2023

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Directions to “ MS. JENNIFER STACY DENEERGAARD LCSW” Practice Location

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