Provider Demographics
NPI:1316130446
Name:HAND, JEANNINE CAROL (NPP)
Entity type:Individual
Prefix:MS
First Name:JEANNINE
Middle Name:CAROL
Last Name:HAND
Suffix:
Gender:F
Credentials:NPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 STONE BLVD
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-6971
Mailing Address - Country:US
Mailing Address - Phone:516-679-2821
Mailing Address - Fax:
Practice Address - Street 1:2-12 W PARK AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-2025
Practice Address - Country:US
Practice Address - Phone:516-889-2332
Practice Address - Fax:516-889-2399
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF400738-1103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)