Provider Demographics
NPI:1548466501
Name:CARDINE, JENNIFER CHRISTIE (MA)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:CHRISTIE
Last Name:CARDINE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:NONE
Other - Middle Name:NONE
Other - Last Name:KRUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:16 DISTILLERY RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-2701
Mailing Address - Country:US
Mailing Address - Phone:845-545-2215
Mailing Address - Fax:
Practice Address - Street 1:16 DISTILLERY RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:NY
Practice Address - Zip Code:10990-2701
Practice Address - Country:US
Practice Address - Phone:845-545-2215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY011377101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program