Healthcare Provider Details

I. General information

NPI: 1437223443
Provider Name (Legal Business Name): JENNIFER BOWER RANKIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER BOWER BREBBIA

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/07/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 S HIGHLAND AVE
PEARL RIVER NY
10965-1614
US

IV. Provider business mailing address

70 S HIGHLAND AVE
PEARL RIVER NY
10965-1614
US

V. Phone/Fax

Practice location:
  • Phone: 860-318-1158
  • Fax:
Mailing address:
  • Phone: 860-318-1158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number303
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number112003
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number005851
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number26708
License Number StateMD
# 5
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number075743-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: