MEDICARE: MRS. JENNIFER MARIE PETERSON LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	116019	NY

General Provider Information

NPI Number	:	1942634472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER MARIE PETERSON LMSW

Provider Business Mailing Address
First Line	:	1761 STATE ROUTE 213
Second Line	:
City	:	ULSTER PARK
State	:	NY
Zip	:	12487-5331
Country	:	US
Telephone Number	:	845-705-7193
Fax Number	:

Provider Business Practice Location Address
First Line	:	664 AARON CT
Second Line	:
City	:	KINGSTON
State	:	NY
Zip	:	12401-2968
Country	:	US
Telephone Number	:	845-705-7193
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/03/2013
Last Update Date	:	02/12/2026

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