Provider Demographics
NPI:1306035753
Name:WILENS, JENNIFER BASSOFF (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:BASSOFF
Last Name:WILENS
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 1:7300 W CAMINO REAL
Mailing Address - Street 2:SUITE 233
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-5512
Mailing Address - Country:US
Mailing Address - Phone:561-338-4994
Mailing Address - Fax:561-883-3174
Practice Address - Street 1:7300 W CAMINO REAL
Practice Address - Street 2:SUITE 233
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-5512
Practice Address - Country:US
Practice Address - Phone:561-338-4994
Practice Address - Fax:561-883-3174
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW67461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical