Provider Demographics
NPI:1437418365
Name:STAFFORD, JENNIFER L (MA, EDM, LMHC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:MA, EDM, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 W 25TH ST
Mailing Address - Street 2:6TH FLOOR, #17
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-7405
Mailing Address - Country:US
Mailing Address - Phone:646-553-4067
Mailing Address - Fax:212-229-2832
Practice Address - Street 1:138 W 25TH ST
Practice Address - Street 2:6TH FLOOR, #17
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-7405
Practice Address - Country:US
Practice Address - Phone:646-553-4067
Practice Address - Fax:212-229-2832
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-12
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP83657101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health