Provider Demographics
NPI:1194094656
Name:TRIPP, JENNIFER ANN (LCSW PERMIT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ANN
Last Name:TRIPP
Suffix:
Gender:F
Credentials:LCSW PERMIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:195 WELLINGTON CT
Mailing Address - Street 2:APT 2F
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-7851
Mailing Address - Country:US
Mailing Address - Phone:718-226-3868
Mailing Address - Fax:718-226-3954
Practice Address - Street 1:375 SEGUINE AVE
Practice Address - Street 2:2 ND FLOOR
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-3932
Practice Address - Country:US
Practice Address - Phone:718-226-3868
Practice Address - Fax:172-226-3954
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY73 P818241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical