Provider Demographics
NPI:1023259561
Name:MORAN, JENELLE (LCSW)
Entity type:Individual
Prefix:
First Name:JENELLE
Middle Name:
Last Name:MORAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:859 CONNETQUOT AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:ISLIP TERRACE
Mailing Address - State:NY
Mailing Address - Zip Code:11752-1429
Mailing Address - Country:US
Mailing Address - Phone:631-277-8300
Mailing Address - Fax:
Practice Address - Street 1:859 CONNETQUOT AVE STE 10
Practice Address - Street 2:
Practice Address - City:ISLIP TERRACE
Practice Address - State:NY
Practice Address - Zip Code:11752-1400
Practice Address - Country:US
Practice Address - Phone:631-277-8300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-12
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY06744-11041C0700X
NY079040-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical