Provider Demographics
NPI:1689566390
Name:VANWEELDEN, JENNA MARIE (LCAT)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:MARIE
Last Name:VANWEELDEN
Suffix:
Gender:F
Credentials:LCAT
Other - Prefix:
Other - First Name:JUNO
Other - Middle Name:
Other - Last Name:VANWEELDEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCAT
Mailing Address - Street 1:66 ROUNDTREE CT
Mailing Address - Street 2:
Mailing Address - City:BEACON
Mailing Address - State:NY
Mailing Address - Zip Code:12508-2128
Mailing Address - Country:US
Mailing Address - Phone:513-262-0808
Mailing Address - Fax:
Practice Address - Street 1:21 OLD MAIN ST STE 207
Practice Address - Street 2:
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-1883
Practice Address - Country:US
Practice Address - Phone:917-300-1332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101200000XBehavioral Health & Social Service ProvidersDrama Therapist