Provider Demographics
NPI:1467621144
Name:JENSEN, CORNELIA (LMSW)
Entity Type:Individual
Prefix:
First Name:CORNELIA
Middle Name:
Last Name:JENSEN
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 W 112TH ST
Mailing Address - Street 2:#6C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026-3752
Mailing Address - Country:US
Mailing Address - Phone:212-749-7763
Mailing Address - Fax:
Practice Address - Street 1:120 W 57TH ST
Practice Address - Street 2:ROOM 1201
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-3320
Practice Address - Country:US
Practice Address - Phone:212-632-4770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY068505-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical