Provider Demographics
NPI:1023813466
Name:MCINTOSH, JENNIFER (PHD, APRN, PMHNP-BC)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:PHD, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:437 WADING RIVER RD
Mailing Address - Street 2:
Mailing Address - City:MANORVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11949-3446
Mailing Address - Country:US
Mailing Address - Phone:631-882-2432
Mailing Address - Fax:
Practice Address - Street 1:175 JERICHO TPKE STE 117
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-4501
Practice Address - Country:US
Practice Address - Phone:631-882-2432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-18
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1462363LP0808X
NYF406685-01363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health