Provider Demographics
NPI:1629144134
Name:JORGENSON, JENNIFER LYNE ROBERTS (LCSW LISW ACSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNE ROBERTS
Last Name:JORGENSON
Suffix:
Gender:F
Credentials:LCSW LISW ACSW
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYNE
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:208 FLYNN AVE
Mailing Address - Street 2:SUITE 3J
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-5429
Mailing Address - Country:US
Mailing Address - Phone:802-488-6920
Mailing Address - Fax:
Practice Address - Street 1:1138 PINE ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-5353
Practice Address - Country:US
Practice Address - Phone:802-488-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2015-08-04
Deactivation Date:2012-08-06
Deactivation Code:
Reactivation Date:2013-08-22
Provider Licenses
StateLicense IDTaxonomies
VT089-01023581041C0700X
OHI00320841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical