Provider Demographics
NPI:1588187934
Name:DE MUCCI, JENNIFER ANNE
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ANNE
Last Name:DE MUCCI
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:GENOVEFFA
Other - Middle Name:ANNE
Other - Last Name:DE MUCCI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:2759 CRESCENT ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-4292
Mailing Address - Country:US
Mailing Address - Phone:347-838-1797
Mailing Address - Fax:
Practice Address - Street 1:2759 CRESCENT ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-4292
Practice Address - Country:US
Practice Address - Phone:347-838-1797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-18
Last Update Date:2017-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool