Provider Demographics
NPI:1215484951
Name:CUOCO, JENNA L
Entity type:Individual
Prefix:MISS
First Name:JENNA
Middle Name:L
Last Name:CUOCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 STEWART AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-4706
Mailing Address - Country:US
Mailing Address - Phone:516-705-3400
Mailing Address - Fax:516-705-3418
Practice Address - Street 1:506 STEWART AVE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-4706
Practice Address - Country:US
Practice Address - Phone:516-705-3400
Practice Address - Fax:516-705-3418
Is Sole Proprietor?:No
Enumeration Date:2016-09-09
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health