Provider Demographics
NPI:1477806370
Name:DENEERGAARD, JENNIFER STACY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:STACY
Last Name:DENEERGAARD
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 1:60 WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:EAST NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:11732-1416
Mailing Address - Country:US
Mailing Address - Phone:516-922-6688
Mailing Address - Fax:516-922-6126
Practice Address - Street 1:60 WALNUT AVE
Practice Address - Street 2:
Practice Address - City:EAST NORWICH
Practice Address - State:NY
Practice Address - Zip Code:11732-1416
Practice Address - Country:US
Practice Address - Phone:516-922-6688
Practice Address - Fax:516-922-6126
Is Sole Proprietor?:No
Enumeration Date:2012-10-17
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY077746-1104100000X
NY093823-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker