Provider Demographics
NPI:1093915753
Name:VANWORMER, JESSICA SUZANNE (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:SUZANNE
Last Name:VANWORMER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 CENTER LN
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054-4018
Mailing Address - Country:US
Mailing Address - Phone:845-514-3035
Mailing Address - Fax:
Practice Address - Street 1:332 KENWOOD AVE
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:NY
Practice Address - Zip Code:12054-2028
Practice Address - Country:US
Practice Address - Phone:845-514-3035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0903331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical