Provider Demographics
NPI:1902011182
Name:STOLTZ, JENNIFER LAUREN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LAUREN
Last Name:STOLTZ
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 1:286 5TH AVE
Mailing Address - Street 2:SUITE 10E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-4512
Mailing Address - Country:US
Mailing Address - Phone:646-554-8900
Mailing Address - Fax:
Practice Address - Street 1:101 W 12TH ST
Practice Address - Street 2:APT 12H
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8142
Practice Address - Country:US
Practice Address - Phone:646-554-8900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0709631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical