Provider Demographics
NPI:1114530185
Name:LINTZERIS, JACQUELINE KONSTANDINA (LMSW)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:KONSTANDINA
Last Name:LINTZERIS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 NOSBAND AVE APT 5G
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-2075
Mailing Address - Country:US
Mailing Address - Phone:914-539-7995
Mailing Address - Fax:
Practice Address - Street 1:1456 ROUTE 22 STE A103
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:NY
Practice Address - Zip Code:10509-4349
Practice Address - Country:US
Practice Address - Phone:845-276-0460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-28
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0923321041C0700X
NY097140104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical