Provider Demographics
NPI:1215928395
Name:UFKO, JENNIFER ANN (LCSW-R, ACSW)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ANN
Last Name:UFKO
Suffix:
Gender:F
Credentials:LCSW-R, ACSW
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:FREESE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-R, ACSW
Mailing Address - Street 1:18 PRINCETON AVENUE
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787
Mailing Address - Country:US
Mailing Address - Phone:631-366-0376
Mailing Address - Fax:
Practice Address - Street 1:18 PRINCETON AVENUE
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787
Practice Address - Country:US
Practice Address - Phone:631-366-0376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-28
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070197-1104100000X
NYR070197-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN28A41Medicare ID - Type UnspecifiedPROVIDER NUMBER