MEDICARE: JENNIFER SUSAN FOOTE LMFT

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	106H00000X	Marriage & Family Therapist	002377	NY

General Provider Information

NPI Number	:	1891507679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER SUSAN FOOTE LMFT

Provider Business Mailing Address
First Line	:	11 RIVERSIDE DR APT 1OW
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10023-3089
Country	:	US
Telephone Number	:	917-929-6296
Fax Number	:

Provider Business Practice Location Address
First Line	:	11 RIVERSIDE DR APT 1OW
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10023-3089
Country	:	US
Telephone Number	:	917-929-6296
Fax Number	:

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

Provider Enumeration Date	:	01/21/2025
Last Update Date	:	01/21/2025

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