Provider Demographics
NPI:1417152133
Name:WOLMAN, JEANNE M (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:JEANNE
Middle Name:M
Last Name:WOLMAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:JEANNE
Other - Middle Name:
Other - Last Name:BADEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:363 ROUTE 111
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787
Mailing Address - Country:US
Mailing Address - Phone:631-455-9123
Mailing Address - Fax:631-751-6736
Practice Address - Street 1:363 RT 111
Practice Address - Street 2:SUITE 103
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787
Practice Address - Country:US
Practice Address - Phone:631-455-9123
Practice Address - Fax:631-751-6736
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0741151104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0741151OtherLICENSED MASTER SOCIAL WO