Provider Demographics
NPI:1194152579
Name:MICHIEL, JENNIFER T (MHC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:T
Last Name:MICHIEL
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 WEICHERS ST
Mailing Address - Street 2:
Mailing Address - City:LAKE RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-3325
Mailing Address - Country:US
Mailing Address - Phone:631-848-7137
Mailing Address - Fax:
Practice Address - Street 1:25 WEICHERS ST
Practice Address - Street 2:
Practice Address - City:LAKE RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-3325
Practice Address - Country:US
Practice Address - Phone:631-848-7137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-01
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005744101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health