Provider Demographics
NPI:1912903584
Name:STREICH, JENNIE R (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNIE
Middle Name:R
Last Name:STREICH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:JENNIE
Other - Middle Name:
Other - Last Name:ROBB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 NORTH 7TH ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17046
Mailing Address - Country:US
Mailing Address - Phone:717-273-1710
Mailing Address - Fax:717-273-1416
Practice Address - Street 1:701 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042
Practice Address - Country:US
Practice Address - Phone:717-274-2741
Practice Address - Fax:717-274-5405
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW014661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA077398LRRMedicare ID - Type Unspecified