MEDICARE: MS. JENNIFER LEE BAME LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041S0200X	School Social Worker	537466	NJ
2	1041C0700X	Clinical Social Worker	44SC05283600	NJ

General Provider Information

NPI Number	:	1558460949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER LEE BAME LCSW

Provider Business Mailing Address
First Line	:	115 FRANKLIN TPKE STE 125
Second Line	:
City	:	MAHWAH
State	:	NJ
Zip	:	07430-1325
Country	:	US
Telephone Number	:	201-371-5113
Fax Number	:	201-419-6082

Provider Business Practice Location Address
First Line	:	115 FRANKLIN TPKE STE 125
Second Line	:
City	:	MAHWAH
State	:	NJ
Zip	:	07430-1325
Country	:	US
Telephone Number	:	201-371-5113
Fax Number	:	201-419-6082

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	01/06/2023

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