Provider Demographics
NPI:1134272180
Name:DESANNA, JEANNE MARIE (LCSW-R)
Entity type:Individual
Prefix:MRS
First Name:JEANNE
Middle Name:MARIE
Last Name:DESANNA
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:JEANNE
Other - Middle Name:MARIE
Other - Last Name:O'GORMAN AND JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-R
Mailing Address - Street 1:80 WASHINGTON ST STE 305
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-2316
Mailing Address - Country:US
Mailing Address - Phone:845-867-4926
Mailing Address - Fax:
Practice Address - Street 1:80 WASHINGTON ST STE 305
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-2316
Practice Address - Country:US
Practice Address - Phone:845-867-4926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-20
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR053069-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical