Provider Demographics
NPI:1609127513
Name:JUMPP-JOHNNY, ZANDRENE HYACINTH (SPEECH IMPROVEMENT T)
Entity Type:Individual
Prefix:MS
First Name:ZANDRENE
Middle Name:HYACINTH
Last Name:JUMPP-JOHNNY
Suffix:
Gender:F
Credentials:SPEECH IMPROVEMENT T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 GLENMORE AVE
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-4112
Mailing Address - Country:US
Mailing Address - Phone:631-965-1431
Mailing Address - Fax:
Practice Address - Street 1:43 GLENMORE AVE
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-4112
Practice Address - Country:US
Practice Address - Phone:631-965-1431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18-001921101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health