Provider Demographics
NPI:1598840944
Name:MITGANG, JENNIFER (LCSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MITGANG
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 1:27010 GRAND CENTRAL PKWY APT 2A
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11005-1102
Mailing Address - Country:US
Mailing Address - Phone:516-395-1272
Mailing Address - Fax:516-706-1305
Practice Address - Street 1:27010 GRAND CENTRAL PKWY APT 2A
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11005-1102
Practice Address - Country:US
Practice Address - Phone:516-395-1272
Practice Address - Fax:516-706-1305
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2025-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR068984104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker