Provider Demographics
NPI:1043828650
Name:FINCH, JEANNE A (DSW, LCSW-R)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:A
Last Name:FINCH
Suffix:
Gender:F
Credentials:DSW, LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2891
Mailing Address - Street 2:
Mailing Address - City:SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-0869
Mailing Address - Country:US
Mailing Address - Phone:631-751-4311
Mailing Address - Fax:
Practice Address - Street 1:234 CHRISTIAN AVE
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-1179
Practice Address - Country:US
Practice Address - Phone:631-751-4311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0366721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical