Individual
MRS. JENNIFER LYNNE MANDATO TRUCIOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CASAC-T, CRPA-P
Contact information
Practice address
CAMELOT, 460 BRIELLE AVENUE, STATEN ISLAND, NY 10309
(134) 792-3137
Mailing address
6465 TRANSIT ROAD, EAST AMHERST, NY 14051
(716) 588-4292
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
37240
NY
104100000X
Social Worker
—
NY
Other
Enumeration date
07/12/2021
Last updated
01/06/2026
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