Provider Demographics
NPI:1245796788
Name:KANTOR, JENNIFER (LICSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:KANTOR
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:R. MAL. HASTIMPHILO DE MOURA, 338 VILA SUZANA
Mailing Address - Street 2:ALAMO 6D
Mailing Address - City:SAO PAULO
Mailing Address - State:SO PAULO
Mailing Address - Zip Code:05641000
Mailing Address - Country:BR
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:R. MAL. HASTIMPHILO DE MOURA, 338 VILA SUZANA
Practice Address - Street 2:ALAMO 6D
Practice Address - City:SAO PAULO
Practice Address - State:SO PAULO
Practice Address - Zip Code:05641000
Practice Address - Country:BR
Practice Address - Phone:206-364-7710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW602060571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALW60206057OtherWASHINGTON STATE DEPARTMENT OF HEALTH