Provider Demographics
NPI:1003445008
Name:LINCOLN, JENNIFER MIKELL (LCSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MIKELL
Last Name:LINCOLN
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 1:1325 CROWLEY LN APT 6
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-6001
Mailing Address - Country:US
Mailing Address - Phone:707-228-6619
Mailing Address - Fax:
Practice Address - Street 1:1325 CROWLEY LN APT 6
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-6001
Practice Address - Country:US
Practice Address - Phone:707-228-6619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-02
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA240261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical