Provider Demographics
NPI:1679399281
Name:KAGARISE, JENNA (MA, NCC, LPC)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:KAGARISE
Suffix:
Gender:F
Credentials:MA, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4343 HANOVER RD
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-8907
Mailing Address - Country:US
Mailing Address - Phone:717-917-6619
Mailing Address - Fax:
Practice Address - Street 1:490 EISENHOWER DR STE 7
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-5247
Practice Address - Country:US
Practice Address - Phone:717-219-3659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-27
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC017947101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty