Provider Demographics
NPI:1255961181
Name:YAGER, JENNIFER RYANN (LMSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RYANN
Last Name:YAGER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4621 MIDDLE SETTLEMENT RD
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-4938
Mailing Address - Country:US
Mailing Address - Phone:315-404-5942
Mailing Address - Fax:
Practice Address - Street 1:122 BUSINESS PARK DR STE 1
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-6321
Practice Address - Country:US
Practice Address - Phone:315-732-3431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-20
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY108785104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker