Provider Demographics
NPI:1811535602
Name:MAMORSKY, JENNA
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:MAMORSKY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 N 4TH PL APT 32M
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11249-3353
Mailing Address - Country:US
Mailing Address - Phone:917-922-1749
Mailing Address - Fax:
Practice Address - Street 1:450 7TH AVE STE 809
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10123-0805
Practice Address - Country:US
Practice Address - Phone:718-260-6042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health