Provider Demographics
NPI:1780576306
Name:NIAMONITOS, JENNIE
Entity type:Individual
Prefix:
First Name:JENNIE
Middle Name:
Last Name:NIAMONITOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14023 ERWIN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-1005
Mailing Address - Country:US
Mailing Address - Phone:215-384-3358
Mailing Address - Fax:
Practice Address - Street 1:507 CORPORATE DR W
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-8011
Practice Address - Country:US
Practice Address - Phone:215-384-3358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW142416104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker