Provider Demographics
NPI:1376360248
Name:SZABO, JENNA RAE (LMSW)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:RAE
Last Name:SZABO
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 1:33 MARVIN LN
Mailing Address - Street 2:
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751-3811
Mailing Address - Country:US
Mailing Address - Phone:631-617-3549
Mailing Address - Fax:
Practice Address - Street 1:1170 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4928
Practice Address - Country:US
Practice Address - Phone:631-587-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY123172-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker