Provider Demographics
NPI:1619471422
Name:DECAPRIA CLOSE, JENNIFER (LCSW-R)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:DECAPRIA CLOSE
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:DECAPRIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8 DENISON PKWY E STE 305
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:NY
Mailing Address - Zip Code:14830-2644
Mailing Address - Country:US
Mailing Address - Phone:607-654-4450
Mailing Address - Fax:
Practice Address - Street 1:8 DENISON PKWY E STE 305
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830-2644
Practice Address - Country:US
Practice Address - Phone:607-654-4450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-19
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0866401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical