Provider Demographics
NPI:1750311445
Name:EINARSSON, JENNIFER (LCSWR)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:EINARSSON
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 THORN AVENUE PO BOX 631
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127
Mailing Address - Country:US
Mailing Address - Phone:716-662-2040
Mailing Address - Fax:716-662-0019
Practice Address - Street 1:27 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:14141-1314
Practice Address - Country:US
Practice Address - Phone:716-592-9301
Practice Address - Fax:716-592-9376
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0523751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000525272001OtherBCBS
NYS87240Medicare UPIN
NYBB5597Medicare ID - Type Unspecified