Provider Demographics
NPI:1700598216
Name:MCCUTCHEN, JENNA (EDUCATION SPECIALIST)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:MCCUTCHEN
Suffix:
Gender:F
Credentials:EDUCATION SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 ADRIENNE LN
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11788-2765
Mailing Address - Country:US
Mailing Address - Phone:631-219-6644
Mailing Address - Fax:
Practice Address - Street 1:11050 71ST RD STE 1M
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4972
Practice Address - Country:US
Practice Address - Phone:347-601-4722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-15
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist