Provider Demographics
NPI:1841428190
Name:ANDERSON, JENNIFER L (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:L
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:SKLADANOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:650 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LACKAWANNA
Mailing Address - State:NY
Mailing Address - Zip Code:14218-1435
Mailing Address - Country:US
Mailing Address - Phone:716-828-9700
Mailing Address - Fax:716-828-9745
Practice Address - Street 1:650 RIDGE RD
Practice Address - Street 2:
Practice Address - City:LACKAWANNA
Practice Address - State:NY
Practice Address - Zip Code:14218-1435
Practice Address - Country:US
Practice Address - Phone:716-828-9700
Practice Address - Fax:716-828-9745
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical