Provider Demographics
NPI:1528580289
Name:COMPETELLO, JENNIFER LYNN
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:COMPETELLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-5723
Mailing Address - Country:US
Mailing Address - Phone:516-426-4724
Mailing Address - Fax:
Practice Address - Street 1:119 N PARK AVE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-4113
Practice Address - Country:US
Practice Address - Phone:516-426-4724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-13
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
NY011743101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program