| Doctor Name: | JENNIFER DENOFA |
| NPI Number: | 1366648792 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSW |
| License Number: | |
| Business Practice Address: | Rear 307 Laird St. Wilkes-barre, PA - 18702 |
| Business Phone Number: | 5704089320 |
| Business Fax Number: | 5704089324 |
| Mailing Address: | 51 Holiday Dr., Apt. 109, KINGSTON |
| State: | PA |
| Postal Code: | 18704 |
| Phone Number: | 6107030152 |
| Fax Number: | 5704089324 |
| NPI Enumeration Date: | 06/22/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM2800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Methadone Clinic |
| Taxonomy Definition: | An entity, facility, or distinct part of a facility providing diagnostic, and replacement maintenance treatment services related to individuals with drug addiction. |