Individual
MS. JACQUELINE LUCILLE RENDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW-R
Contact information
Practice address
210 EMERSON ST, PORT JEFFERSON, NY 11777-1605
(631) 331-3895
Mailing address
210 EMERSON ST, PORT JEFFERSON, NY 11777-1605
(631) 331-3895
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
R039200-1
NY
1041S0200X
School Social Worker
Primary
R039200-1
NY
Other
Enumeration date
05/30/2007
Last updated
09/11/2025
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