Provider Demographics
NPI:1356783013
Name:DIPERNA SOHO, JENNIFER L (LMHC)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:L
Last Name:DIPERNA SOHO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 FRANKLIN LN APT E
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-1175
Mailing Address - Country:US
Mailing Address - Phone:917-903-3582
Mailing Address - Fax:
Practice Address - Street 1:3930 RICHMOND AVENUE #105
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-5104
Practice Address - Country:US
Practice Address - Phone:718-777-5243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-23
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005803-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health