Provider Demographics
NPI:1083413942
Name:STOTTLAR, JENNIFER LYNNE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNNE
Last Name:STOTTLAR
Suffix:
Gender:
Credentials:LMSW
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:LYNNE
Other - Last Name:CORNISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:301 N WASHINGTON STREET
Mailing Address - Street 2:SUITE 2470
Mailing Address - City:HERKIMER
Mailing Address - State:NY
Mailing Address - Zip Code:13350
Mailing Address - Country:US
Mailing Address - Phone:315-867-1465
Mailing Address - Fax:315-867-1469
Practice Address - Street 1:301 N WASHINGTON STREET
Practice Address - Street 2:SUITE 2470
Practice Address - City:HERKIMER
Practice Address - State:NY
Practice Address - Zip Code:13350
Practice Address - Country:US
Practice Address - Phone:315-867-1465
Practice Address - Fax:315-867-1469
Is Sole Proprietor?:No
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY124368104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker