Provider Demographics
NPI:1760422166
Name:BROWN, JENNIFER AMENDOLARI (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:AMENDOLARI
Last Name:BROWN
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 1:2565 THOMPSON BRIDGE RD STE 111
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-1723
Mailing Address - Country:US
Mailing Address - Phone:917-494-1410
Mailing Address - Fax:
Practice Address - Street 1:2565 THOMPSON BRIDGE RD STE 111
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-1723
Practice Address - Country:US
Practice Address - Phone:917-494-1410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO597861041C0700X
GACSW0041681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical