Provider Demographics
NPI:1104607845
Name:BUCK, JENNIFER RENEE (LSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RENEE
Last Name:BUCK
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KERSEY
Mailing Address - State:PA
Mailing Address - Zip Code:15846-2029
Mailing Address - Country:US
Mailing Address - Phone:814-335-2521
Mailing Address - Fax:
Practice Address - Street 1:427 N SAINT MARYS ST
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:PA
Practice Address - Zip Code:15857-3657
Practice Address - Country:US
Practice Address - Phone:814-834-9283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW140815104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker