Provider Demographics
NPI:1114549250
Name:JENNINGS, ALEXANDRIA DANIELLE (LMSW)
Entity Type:Individual
Prefix:MISS
First Name:ALEXANDRIA
Middle Name:DANIELLE
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 HILTON AVE
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-4193
Mailing Address - Country:US
Mailing Address - Phone:315-368-6417
Mailing Address - Fax:
Practice Address - Street 1:1203 HILTON AVE
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-4193
Practice Address - Country:US
Practice Address - Phone:315-368-6417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-12
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY109321104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY109321Medicaid