Provider Demographics
NPI:1902408180
Name:GREGORY, JENNA (LMSW)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:GREGORY
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 1:2745 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:12534-8905
Mailing Address - Country:US
Mailing Address - Phone:518-567-3369
Mailing Address - Fax:
Practice Address - Street 1:2745 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12534-8905
Practice Address - Country:US
Practice Address - Phone:518-567-3369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY110506104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker