Provider Demographics
NPI:1922497494
Name:WITKOWSKI, JENNA LYNN (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:LYNN
Last Name:WITKOWSKI
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 1:391 WASHINGTON ST STE 8
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203-2108
Mailing Address - Country:US
Mailing Address - Phone:716-361-8190
Mailing Address - Fax:716-768-1829
Practice Address - Street 1:391 WASHINGTON ST STE 8
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-2108
Practice Address - Country:US
Practice Address - Phone:716-361-8190
Practice Address - Fax:716-768-1829
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY085-070-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical