Provider Demographics
NPI:1447773064
Name:MCLOUGHLIN, JENNA LYNN (LMSW)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:LYNN
Last Name:MCLOUGHLIN
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 1:132 LEE AVE
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-5810
Mailing Address - Country:US
Mailing Address - Phone:516-313-9433
Mailing Address - Fax:
Practice Address - Street 1:12520 SUTPHIN BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-2340
Practice Address - Country:US
Practice Address - Phone:718-322-9012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-25
Last Update Date:2017-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY080391-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical