Provider Demographics
NPI:1750840336
Name:LERNER, JODI
Entity Type:Individual
Prefix:MRS
First Name:JODI
Middle Name:
Last Name:LERNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 WHITE HILL RD
Mailing Address - Street 2:
Mailing Address - City:COLD SPRING HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11724-1107
Mailing Address - Country:US
Mailing Address - Phone:646-436-5634
Mailing Address - Fax:
Practice Address - Street 1:84 WHITE HILL RD
Practice Address - Street 2:
Practice Address - City:COLD SPRING HARBOR
Practice Address - State:NY
Practice Address - Zip Code:11724-1107
Practice Address - Country:US
Practice Address - Phone:631-427-7979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-13
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY105963-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker