Provider Demographics
NPI:1023756939
Name:BASHANT, JENNIFER LONG (LMSW, PHD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LONG
Last Name:BASHANT
Suffix:
Gender:F
Credentials:LMSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 FOREST DR
Mailing Address - Street 2:
Mailing Address - City:VOORHEESVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12186-9530
Mailing Address - Country:US
Mailing Address - Phone:518-496-2915
Mailing Address - Fax:
Practice Address - Street 1:17 FOREST DR
Practice Address - Street 2:
Practice Address - City:VOORHEESVILLE
Practice Address - State:NY
Practice Address - Zip Code:12186-9530
Practice Address - Country:US
Practice Address - Phone:518-496-2915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY078247104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker