Provider Demographics
NPI:1477057024
Name:CARDAMONE, JENNIFER PAYNE (LMSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:PAYNE
Last Name:CARDAMONE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 NORTH LARK STREET
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12210
Mailing Address - Country:US
Mailing Address - Phone:518-475-6619
Mailing Address - Fax:
Practice Address - Street 1:50 LARK ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12210-1518
Practice Address - Country:US
Practice Address - Phone:518-475-6619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-20
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0900071041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY090007OtherLMSW
NY1418665OtherPUBLIC SCHOOL TEACHER CERT.