Healthcare Provider Details

I. General information

NPI: 1538272265
Provider Name (Legal Business Name): JENNESS CLAIRMONT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2691 STATE ROUTE 9 # 204
MALTA NY
12020-4319
US

IV. Provider business mailing address

2691 STATE ROUTE 9 # 204
MALTA NY
12020-4319
US

V. Phone/Fax

Practice location:
  • Phone: 518-400-1448
  • Fax: 518-886-8899
Mailing address:
  • Phone: 518-400-1448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number071476-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: