MEDICARE: JENNIFER MITGANG 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
1	104100000X	Social Worker	R068984	NY

General Provider Information

NPI Number	:	1598840944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER MITGANG LCSW

Provider Business Mailing Address
First Line	:	27010 GRAND CENTRAL PKWY APT 2A
Second Line	:
City	:	FLORAL PARK
State	:	NY
Zip	:	11005-1102
Country	:	US
Telephone Number	:	516-395-1272
Fax Number	:	516-706-1305

Provider Business Practice Location Address
First Line	:	27010 GRAND CENTRAL PKWY APT 2A
Second Line	:
City	:	FLORAL PARK
State	:	NY
Zip	:	11005-1102
Country	:	US
Telephone Number	:	516-395-1272
Fax Number	:	516-706-1305

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

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	12/18/2025

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