Provider Demographics
NPI:1053328344
Name:DITTMAN, JEAN ISABELLA (MSW, LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:ISABELLA
Last Name:DITTMAN
Suffix:
Gender:F
Credentials:MSW, LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 SHERBROOKE AVE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-3422
Mailing Address - Country:US
Mailing Address - Phone:716-862-6016
Mailing Address - Fax:716-834-7329
Practice Address - Street 1:VA WNY HEALTHCARE SYSTEM/528
Practice Address - Street 2:3495 BAILEY AVENUE
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-0000
Practice Address - Country:US
Practice Address - Phone:716-862-6016
Practice Address - Fax:716-834-7329
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR036533-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical