MEDICARE: RENEE JUNGREIS

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	103TC2200X	Clinical Child & Adolescent Psychologist

General Provider Information

NPI Number	:	1568104909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENEE JUNGREIS

Provider Business Mailing Address
First Line	:	1649 E 23RD ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1518
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1649 E 23RD ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1518
Country	:	US
Telephone Number	:	718-338-5319
Fax Number	:

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

Provider Enumeration Date	:	04/07/2022
Last Update Date	:	04/07/2022

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Directions to “ RENEE JUNGREIS ” Practice Location

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