1013570449 NPI number — JENNIFER MARIE BARTKOWIAK M.A., LMHC

Table of content: JENNIFER MARIE BARTKOWIAK M.A., LMHC (NPI 1013570449)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013570449 NPI number — JENNIFER MARIE BARTKOWIAK M.A., LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARTKOWIAK
Provider First Name:
JENNIFER
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.A., LMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013570449
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/22/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8297 OLD POLAND RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BARNEVELD
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13304-2204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 WILLIAMS ST STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLINTON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13323-1748
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-317-6517
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/22/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  007020 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)