Provider Demographics
NPI:1720590326
Name:SCOTT, JENNIFER R (LMSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:R
Last Name:SCOTT
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 1:6735 RIDGE BLVD APT 5E
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-5237
Mailing Address - Country:US
Mailing Address - Phone:347-287-2829
Mailing Address - Fax:
Practice Address - Street 1:3109 37TH ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-3932
Practice Address - Country:US
Practice Address - Phone:718-721-5125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-04
Last Update Date:2017-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY100938104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker