Provider Demographics
NPI:1487327011
Name:FALLERT, JENNA MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:MARIE
Last Name:FALLERT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 MCNEILLY AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15216-3401
Mailing Address - Country:US
Mailing Address - Phone:412-904-8866
Mailing Address - Fax:
Practice Address - Street 1:3757 LIBRARY RD STE 200
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15234-2271
Practice Address - Country:US
Practice Address - Phone:412-904-8866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0213731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical