Provider Demographics
NPI:1891507679
Name:FOOTE, JENNIFER SUSAN (LMFT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SUSAN
Last Name:FOOTE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:JENIFER
Other - Middle Name:
Other - Last Name:FOOTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11 RIVERSIDE DR APT 1OW
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-3089
Mailing Address - Country:US
Mailing Address - Phone:917-929-6296
Mailing Address - Fax:
Practice Address - Street 1:11 RIVERSIDE DR APT 1OW
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-3089
Practice Address - Country:US
Practice Address - Phone:917-929-6296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002377106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist