Provider Demographics
NPI:1689126229
Name:ROSE, JENNA (LMHC)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:
Other - Last Name:RISLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30 CRESCENT AVE
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-5100
Mailing Address - Country:US
Mailing Address - Phone:518-584-3600
Mailing Address - Fax:518-584-3747
Practice Address - Street 1:30 CRESCENT AVE
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-5100
Practice Address - Country:US
Practice Address - Phone:518-584-3600
Practice Address - Fax:518-584-3747
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-31
Last Update Date:2023-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
NY009039101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No251S00000XAgenciesCommunity/Behavioral Health