Provider Demographics
NPI:1316324114
Name:JENNINGS COUNSELING SERVICES, LCSW, PC
Entity type:Organization
Organization Name:JENNINGS COUNSELING SERVICES, LCSW, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:JENNINGS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSWR
Authorized Official - Phone:516-410-1122
Mailing Address - Street 1:99 HILLSIDE AVE
Mailing Address - Street 2:SUITE J
Mailing Address - City:WILLISTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11596-2333
Mailing Address - Country:US
Mailing Address - Phone:516-410-1122
Mailing Address - Fax:
Practice Address - Street 1:99 HILLSIDE AVE
Practice Address - Street 2:SUITE J
Practice Address - City:WILLISTON PARK
Practice Address - State:NY
Practice Address - Zip Code:11596-2333
Practice Address - Country:US
Practice Address - Phone:516-410-1122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-30
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004586101YM0800X
NY08281111041C0700X
NY0811161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty