Healthcare Provider Details

I. General information

NPI: 1548399306
Provider Name (Legal Business Name): JENNIFER F DOVIN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 08/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 N MAIN ST
CORTLAND NY
13045-2130
US

IV. Provider business mailing address

10 N MAIN ST
CORTLAND NY
13045-2130
US

V. Phone/Fax

Practice location:
  • Phone: 607-753-0234
  • Fax: 607-753-0286
Mailing address:
  • Phone: 607-753-0234
  • Fax: 607-753-0286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR0528291
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: