Provider Demographics
NPI:1477994168
Name:ST PIERRE, JENNA (LCAT, MT-BC)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:ST PIERRE
Suffix:
Gender:F
Credentials:LCAT, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 MARINE AVE APT A9
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-8038
Mailing Address - Country:US
Mailing Address - Phone:413-519-8113
Mailing Address - Fax:347-466-6951
Practice Address - Street 1:351 MARINE AVE APT A9
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-8038
Practice Address - Country:US
Practice Address - Phone:413-519-8113
Practice Address - Fax:347-466-6951
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-10
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225A00000X
NY002182101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist