Provider Demographics
NPI:1760770648
Name:BRANDT, JENNIFER (LCSW-R)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BRANDT
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70-50 AUSTIN STREET
Mailing Address - Street 2:SUITE LL110A
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375
Mailing Address - Country:US
Mailing Address - Phone:410-422-7299
Mailing Address - Fax:
Practice Address - Street 1:7050 AUSTIN ST STE LL110A
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4703
Practice Address - Country:US
Practice Address - Phone:410-422-7299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-13
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY065337104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker