Healthcare Provider Details

I. General information

NPI: 1578180188
Provider Name (Legal Business Name): JENNIFER LYNN PRELL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2020
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3635 BELL BLVD STE 203
BAYSIDE NY
11361-2097
US

IV. Provider business mailing address

564 NIAGARA ST STE 142
BUFFALO NY
14201-1108
US

V. Phone/Fax

Practice location:
  • Phone: 718-504-9256
  • Fax:
Mailing address:
  • Phone: 716-359-1550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number103150
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: