| Doctor Name: | MRS. JENNIFER KANTOR JACKMAN |
| NPI Number: | 1215225164 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | 075500 |
| Business Practice Address: | 3630 Hill Blvd Suite 204a Jefferson Valley, NY - 105351502 |
| Business Phone Number: | 9143022858 |
| Business Fax Number: | 9143022859 |
| Mailing Address: | 3630 Hill Blvd, Suite 204a JEFFERSON VALLEY |
| State: | NY |
| Postal Code: | 105351502 |
| Phone Number: | 9143022858 |
| Fax Number: | 9143022859 |
| NPI Enumeration Date: | 07/13/2011 |
| NPI Last Update Date: | 07/13/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 075500 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |