Provider Demographics
NPI:1316294333
Name:MARTIN, JENNIFER LYNN (LMHC)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:DOLLARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:6265 SHERIDAN DRIVE
Mailing Address - Street 2:SUITE 122
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221
Mailing Address - Country:US
Mailing Address - Phone:716-204-5552
Mailing Address - Fax:716-204-5557
Practice Address - Street 1:6265 SHERIDAN DR
Practice Address - Street 2:SUITE 122
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-4833
Practice Address - Country:US
Practice Address - Phone:716-204-5552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-08
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005178-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health