1245796788 NPI number — JENNIFER KANTOR LICSW

Table of content: JENNIFER KANTOR LICSW (NPI 1245796788)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245796788 NPI number — JENNIFER KANTOR LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KANTOR
Provider First Name:
JENNIFER
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LICSW
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:
1245796788
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
R. MAL. HASTIMPHILO DE MOURA, 338 VILA SUZANA
Provider Second Line Business Mailing Address:
ALAMO 6D
Provider Business Mailing Address City Name:
SAO PAULO
Provider Business Mailing Address State Name:
SO PAULO
Provider Business Mailing Address Postal Code:
05641000
Provider Business Mailing Address Country Code:
BR
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:
R. MAL. HASTIMPHILO DE MOURA, 338 VILA SUZANA
Provider Second Line Business Practice Location Address:
ALAMO 6D
Provider Business Practice Location Address City Name:
SAO PAULO
Provider Business Practice Location Address State Name:
SO PAULO
Provider Business Practice Location Address Postal Code:
05641000
Provider Business Practice Location Address Country Code:
BR
Provider Business Practice Location Address Telephone Number:
206-364-7710
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/20/2019

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: 1041C0700X , with the licence number:  LW60206057 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: LW60206057 . This is a "WASHINGTON STATE DEPARTMENT OF HEALTH" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com