Provider Demographics
NPI:1598446478
Name:LACORTE, JENNINE M (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNINE
Middle Name:M
Last Name:LACORTE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JENNINE
Other - Middle Name:M
Other - Last Name:RUSSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3 OVERLOOK AVE
Mailing Address - Street 2:
Mailing Address - City:EMERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07630-1017
Mailing Address - Country:US
Mailing Address - Phone:201-919-6394
Mailing Address - Fax:
Practice Address - Street 1:3 OVERLOOK AVE
Practice Address - Street 2:
Practice Address - City:EMERSON
Practice Address - State:NJ
Practice Address - Zip Code:07630-1017
Practice Address - Country:US
Practice Address - Phone:201-919-6394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052889001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical