Provider Demographics
NPI:1467100347
Name:THOMAS, JENNYFERE (LP)
Entity Type:Individual
Prefix:
First Name:JENNYFERE
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38305 TOWN GREEN DR
Mailing Address - Street 2:
Mailing Address - City:ELMSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:10523-1728
Mailing Address - Country:US
Mailing Address - Phone:917-364-9177
Mailing Address - Fax:
Practice Address - Street 1:38305 TOWN GREEN DR
Practice Address - Street 2:
Practice Address - City:ELMSFORD
Practice Address - State:NY
Practice Address - Zip Code:10523-1728
Practice Address - Country:US
Practice Address - Phone:917-364-9177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-10
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP110616101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health