Provider Demographics
NPI:1780484253
Name:SCHULTZ, JENNIFER SUE (LCSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SUE
Last Name:SCHULTZ
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 BRANDYWINE DR
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14072-1475
Mailing Address - Country:US
Mailing Address - Phone:716-622-8502
Mailing Address - Fax:716-622-8502
Practice Address - Street 1:74 BRANDYWINE DR
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NY
Practice Address - Zip Code:14072-1475
Practice Address - Country:US
Practice Address - Phone:716-622-8502
Practice Address - Fax:716-622-8502
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-14
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0962671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical