Healthcare Provider Details

I. General information

NPI: 1215928395
Provider Name (Legal Business Name): JENNIFER ANN UFKO LCSW-R, ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER ANN FREESE LCSW-R, ACSW

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 05/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 PRINCETON AVENUE
SMITHTOWN NY
11787
US

IV. Provider business mailing address

18 PRINCETON AVENUE
SMITHTOWN NY
11787
US

V. Phone/Fax

Practice location:
  • Phone: 631-366-0376
  • Fax:
Mailing address:
  • Phone: 631-366-0376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number070197-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR070197-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: