Provider Demographics
NPI:1902228778
Name:SORENSEN, JEANINE M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JEANINE
Middle Name:M
Last Name:SORENSEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 LINDELL BLVD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-1736
Mailing Address - Country:US
Mailing Address - Phone:516-445-8503
Mailing Address - Fax:
Practice Address - Street 1:601 LINDELL BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-1736
Practice Address - Country:US
Practice Address - Phone:516-445-8503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool