Provider Demographics
NPI:1295991941
Name:ABCUG, JENNIFER (LCSW-R)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:ABCUG
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 W END AVE APT 105
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-6561
Mailing Address - Country:US
Mailing Address - Phone:917-370-5664
Mailing Address - Fax:
Practice Address - Street 1:365 W END AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-6511
Practice Address - Country:US
Practice Address - Phone:917-370-5664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-01
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR058028-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical