Provider Demographics
NPI:1942434766
Name:DOKTORCIK, JENNIFER LINDSEY (MSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LINDSEY
Last Name:DOKTORCIK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 LEROY ST
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-1601
Mailing Address - Country:US
Mailing Address - Phone:949-468-7086
Mailing Address - Fax:
Practice Address - Street 1:825 LEROY ST
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-1601
Practice Address - Country:US
Practice Address - Phone:949-468-7086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-07
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801088671041C0700X
CAASW 207191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical