Provider Demographics
NPI:1639771611
Name:TODARO, JENNIFER (APC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:TODARO
Suffix:
Gender:F
Credentials:APC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1648 WALDEN POND RD
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-2092
Mailing Address - Country:US
Mailing Address - Phone:678-231-0134
Mailing Address - Fax:
Practice Address - Street 1:1648 WALDEN POND RD
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-2092
Practice Address - Country:US
Practice Address - Phone:678-231-0134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC007461101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty