Provider Demographics
NPI:1629484688
Name:PRINCIPATO, JENNA (LMSW)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:PRINCIPATO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:196 ROCKAWAY PKWY
Mailing Address - Street 2:APT. 6K
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-3400
Mailing Address - Country:US
Mailing Address - Phone:516-395-6829
Mailing Address - Fax:
Practice Address - Street 1:9729 64TH RD
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-2259
Practice Address - Country:US
Practice Address - Phone:516-395-6829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0918121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical