Provider Demographics
NPI:1720551997
Name:LINO, JENNIFER JOANNE (LMSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JOANNE
Last Name:LINO
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 1:39 PATRICIA DR
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-3328
Mailing Address - Country:US
Mailing Address - Phone:631-624-0295
Mailing Address - Fax:
Practice Address - Street 1:39 PATRICIA DR
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-3328
Practice Address - Country:US
Practice Address - Phone:631-624-0295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY085306-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty