Provider Demographics
NPI:1295166395
Name:KITTINGER, JENNIFER E (LCSW)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:E
Last Name:KITTINGER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JENNIDER
Other - Middle Name:E
Other - Last Name:HENSLEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4500 SAN PABLO RD S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-1865
Mailing Address - Country:US
Mailing Address - Phone:904-716-2742
Mailing Address - Fax:
Practice Address - Street 1:4500 SAN PABLO RD S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-1865
Practice Address - Country:US
Practice Address - Phone:904-956-3269
Practice Address - Fax:904-956-3201
Is Sole Proprietor?:No
Enumeration Date:2013-11-29
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW106281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL12617481OtherCAQH