Provider Demographics
NPI:1215225164
Name:JACKMAN, JENNIFER KANTOR (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:KANTOR
Last Name:JACKMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3630 HILL BLVD
Mailing Address - Street 2:SUITE 204A
Mailing Address - City:JEFFERSON VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10535-1502
Mailing Address - Country:US
Mailing Address - Phone:914-302-2858
Mailing Address - Fax:914-302-2859
Practice Address - Street 1:3630 HILL BLVD
Practice Address - Street 2:SUITE 204A
Practice Address - City:JEFFERSON VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10535-1502
Practice Address - Country:US
Practice Address - Phone:914-302-2858
Practice Address - Fax:914-302-2859
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-13
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0755001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical