Provider Demographics
NPI:1831835842
Name:COONCE, JENNIFER (LP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:COONCE
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 S OXFORD ST # 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-1305
Mailing Address - Country:US
Mailing Address - Phone:917-859-4921
Mailing Address - Fax:
Practice Address - Street 1:300 CADMAN PLZ W FL 12
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-3226
Practice Address - Country:US
Practice Address - Phone:917-859-4921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001015103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis