Provider Demographics
NPI:1093960346
Name:KURKO, JENNIFER FENNELL (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:FENNELL
Last Name:KURKO
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 1:24 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-3110
Mailing Address - Country:US
Mailing Address - Phone:917-859-5713
Mailing Address - Fax:
Practice Address - Street 1:340 TRINITY PL
Practice Address - Street 2:
Practice Address - City:MALVERNE
Practice Address - State:NY
Practice Address - Zip Code:11565-1248
Practice Address - Country:US
Practice Address - Phone:907-859-5713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-28
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8524361041C0700X
NY0598571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical