Provider Demographics
NPI:1952587891
Name:FARACI, JENNIE LEE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNIE
Middle Name:LEE
Last Name:FARACI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:JENNIE
Other - Middle Name:LEE
Other - Last Name:NICHOLAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2386 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11783-2933
Mailing Address - Country:US
Mailing Address - Phone:631-807-7937
Mailing Address - Fax:
Practice Address - Street 1:20 HICKSVILLE RD
Practice Address - Street 2:SUITE 5
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-5819
Practice Address - Country:US
Practice Address - Phone:631-807-7937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0837271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical