Healthcare Provider Details

I. General information

NPI: 1851552038
Provider Name (Legal Business Name): JENNIFER LAWTON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2008
Last Update Date: 05/20/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7403 COMMONWEALTH BLVD BLDG 55
BELLEROSE NY
11426-1839
US

IV. Provider business mailing address

7403 COMMONWEALTH BLVD BLDG 55
BELLEROSE NY
11426-1839
US

V. Phone/Fax

Practice location:
  • Phone: 917-685-1032
  • Fax:
Mailing address:
  • Phone: 917-685-1032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number076670-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number080582
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: