Provider Demographics
NPI:1972736502
Name:DISALVO, JENNA ROSE (MS)
Entity type:Individual
Prefix:MS
First Name:JENNA
Middle Name:ROSE
Last Name:DISALVO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2288 SECOND STREET PIKEDELAWARE VALLEY CHILDREN'S CENTE
Mailing Address - Street 2:STE. 6
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940
Mailing Address - Country:US
Mailing Address - Phone:215-598-0223
Mailing Address - Fax:
Practice Address - Street 1:2288 2ND STREET PIKE
Practice Address - Street 2:STE.6
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-4108
Practice Address - Country:US
Practice Address - Phone:215-598-0223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-31
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist