Whaley Gundersen, Jennifer Dana

Whaley Gundersen, Jennifer Dana is an individual health care provider with primary practice located at 600 Johnson Ave Ste C13 , Bohemia NY 11716-2674. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Whaley Gundersen, Jennifer Dana can be contacted via phone (631) 960-8575.

Contact Information

Primary practice address
600 Johnson Ave Ste C13 Bohemia NY 11716-2674
Phone: (631) 960-8575
Fax: (631) 315-1090
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X 077561 New York
Behavioral Health & Social Service Providers / Clinical 1041C0700X 079761-1 New York

Profile Details

NPI number 1881831949
LBN Legal business name Whaley Gundersen, Jennifer Dana
Credentials LCSW, CASAC
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 12th, 2009
Last updated Apr 2nd, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1881831949 NPPES
New York MEDICAID 01781144

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