Provider Demographics
NPI:1164873238
Name:SANDERS, JENNIFER E (LMSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:E
Last Name:SANDERS
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 1:113 PARK PL
Mailing Address - Street 2:
Mailing Address - City:SCHOHARIE
Mailing Address - State:NY
Mailing Address - Zip Code:12157-5211
Mailing Address - Country:US
Mailing Address - Phone:518-298-2031
Mailing Address - Fax:518-295-8724
Practice Address - Street 1:113 PARK PL
Practice Address - Street 2:
Practice Address - City:SCHOHARIE
Practice Address - State:NY
Practice Address - Zip Code:12157-5211
Practice Address - Country:US
Practice Address - Phone:518-298-2031
Practice Address - Fax:518-295-8724
Is Sole Proprietor?:No
Enumeration Date:2016-06-29
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0961271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00555784OtherAGENCY MEDICAIID