Provider Demographics
NPI:1578701579
Name:BAKAL, JENNIFER RACHAEL (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RACHAEL
Last Name:BAKAL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 E 96TH ST APT 17R
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-3947
Mailing Address - Country:US
Mailing Address - Phone:212-426-6826
Mailing Address - Fax:
Practice Address - Street 1:116 JOHN ST FL 27
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-3414
Practice Address - Country:US
Practice Address - Phone:212-385-0086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-28
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070840-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical