Provider Demographics
NPI:1447910344
Name:JENNIFER BRENT LCSW PC
Entity type:Organization
Organization Name:JENNIFER BRENT LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BRENT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:631-559-9626
Mailing Address - Street 1:1777 VETERANS MEMORIAL HWY STE 14
Mailing Address - Street 2:
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-1555
Mailing Address - Country:US
Mailing Address - Phone:631-559-9626
Mailing Address - Fax:
Practice Address - Street 1:1777 VETERANS MEMORIAL HWY STE 14
Practice Address - Street 2:
Practice Address - City:ISLANDIA
Practice Address - State:NY
Practice Address - Zip Code:11749-1555
Practice Address - Country:US
Practice Address - Phone:631-559-9626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-20
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty