Provider Demographics
NPI:1487723045
Name:BORDONARO-BENSON, JENNIFER LYN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYN
Last Name:BORDONARO-BENSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYN
Other - Last Name:BORDONARO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:6760 MINOA BRIDGEPORT RD
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-9424
Mailing Address - Country:US
Mailing Address - Phone:315-857-5256
Mailing Address - Fax:
Practice Address - Street 1:3070 BELGIUM RD
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027
Practice Address - Country:US
Practice Address - Phone:315-253-8401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071304-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical