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General NPI Number Information
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NPI Number | 1033526132
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Entity Type | Individual
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Provider Name | JENNIFER TISSOT VAN PATOT LCSW
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Gender | Female
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Dates
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Enumeration Date | 07/21/2014
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Last Update Date | 07/21/2014
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Provider Practice Location Address
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Address Line | 24 DEWEY MOUNTAIN RD
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City | SARANAC LAKE
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State | NY
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Zip | 12983-8319
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Country | US
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Telephone | 518-572-4597
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Fax |
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Provider Business Mailing Address
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Address Line | 24 DEWEY MOUNTAIN RD
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City | SARANAC LAKE
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State | NY
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Zip | 12983-8319
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Country | US
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Telephone | 518-572-4597
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | R041270-1
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License Number State | NY
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