Provider Demographics
NPI:1891099701
Name:SANCLEMENTS, JENNIFER A (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:A
Last Name:SANCLEMENTS
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 1:1123 BROADWAY
Mailing Address - Street 2:SUITE 1020
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-2007
Mailing Address - Country:US
Mailing Address - Phone:917-975-9195
Mailing Address - Fax:
Practice Address - Street 1:1123 BROADWAY
Practice Address - Street 2:SUITE 1020
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-2007
Practice Address - Country:US
Practice Address - Phone:917-975-9195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-06
Last Update Date:2012-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0778141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical