Provider Demographics
NPI:1932895059
Name:JEANTY, MURIEL (LCSW)
Entity Type:Individual
Prefix:
First Name:MURIEL
Middle Name:
Last Name:JEANTY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 76
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11553-0076
Mailing Address - Country:US
Mailing Address - Phone:516-659-0499
Mailing Address - Fax:
Practice Address - Street 1:100 BROADHOLLOW RD STE 317
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-4813
Practice Address - Country:US
Practice Address - Phone:516-659-0499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0951331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical