Provider Demographics
NPI:1053671446
Name:REID, JENNIFER ANNE (SC, BSW)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:ANNE
Last Name:REID
Suffix:
Gender:F
Credentials:SC, BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 E FAYETTE ST STE B
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-1953
Mailing Address - Country:US
Mailing Address - Phone:315-435-3230
Mailing Address - Fax:315-435-2678
Practice Address - Street 1:501 E FAYETTE ST STE B
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-1953
Practice Address - Country:US
Practice Address - Phone:315-435-3230
Practice Address - Fax:315-435-2678
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator