Provider Demographics
NPI:1437223443
Name:RANKIN, JENNIFER BOWER (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:BOWER
Last Name:RANKIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:BOWER
Other - Last Name:BREBBIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:70 S HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10965-1614
Mailing Address - Country:US
Mailing Address - Phone:860-318-1158
Mailing Address - Fax:
Practice Address - Street 1:70 S HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:PEARL RIVER
Practice Address - State:NY
Practice Address - Zip Code:10965-1614
Practice Address - Country:US
Practice Address - Phone:860-318-1158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3031041C0700X
MA1120031041C0700X
CT0058511041C0700X
MD267081041C0700X
NY075743-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT140005851CT01OtherANTHEM PROVIDER ID
CT140005851CT01OtherANTHEM PROVIDER ID