Provider Demographics
NPI:1396521753
Name:BIRT, JENNIFER RENEE (CRC, CVE, LPC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RENEE
Last Name:BIRT
Suffix:
Gender:F
Credentials:CRC, CVE, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5837 ROUTE 220
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:PA
Mailing Address - Zip Code:18833-8991
Mailing Address - Country:US
Mailing Address - Phone:570-855-9088
Mailing Address - Fax:
Practice Address - Street 1:1111 E END BLVD
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18711-0030
Practice Address - Country:US
Practice Address - Phone:570-824-3521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-01
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC014581101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional