Provider Demographics
NPI:1558646646
Name:PERRY, JENNIFER NICOLE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:NICOLE
Last Name:PERRY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:NICOLE
Other - Last Name:GLASS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:740 S LIMESTONE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0284
Mailing Address - Country:US
Mailing Address - Phone:859-323-6228
Mailing Address - Fax:859-323-3795
Practice Address - Street 1:740 N LIMESTONE
Practice Address - Street 2:J420
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-1683
Practice Address - Country:US
Practice Address - Phone:859-323-6228
Practice Address - Fax:859-323-3795
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY34111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical