Provider Demographics
NPI:1265512651
Name:LANCASTER, JENNIFER M (PHD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:M
Last Name:LANCASTER
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 N VILLAGE AVE STE 216
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-3701
Mailing Address - Country:US
Mailing Address - Phone:631-321-7107
Mailing Address - Fax:631-321-7108
Practice Address - Street 1:165 N VILLAGE AVE STE 216
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-3701
Practice Address - Country:US
Practice Address - Phone:631-321-7107
Practice Address - Fax:631-321-7108
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014818103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVM832Medicare UPIN
NY292424494Medicare UPIN
NY6806042Medicare UPIN
NYVM8321Medicare ID - Type Unspecified
NY796833000Medicare UPIN
NYP3619449Medicare UPIN
NY453092Medicare UPIN
NY7004745Medicare UPIN