Provider Demographics
NPI:1447535497
Name:ANDREOPOULOS, JENNIFER LYNN (LCSW-R)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:ANDREOPOULOS
Suffix:
Gender:F
Credentials:LCSW-R
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 116
Mailing Address - Street 2:41 SOUTH PHILLIPS AVENUE
Mailing Address - City:SPEONK
Mailing Address - State:NY
Mailing Address - Zip Code:11972
Mailing Address - Country:US
Mailing Address - Phone:631-325-1033
Mailing Address - Fax:
Practice Address - Street 1:185 N DUNTON AVE
Practice Address - Street 2:
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-5587
Practice Address - Country:US
Practice Address - Phone:631-730-1675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0748871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical