Provider Demographics
NPI:1174740716
Name:LASKER, JENNIFER BETH (MSW)
Entity type:Individual
Prefix:PROF
First Name:JENNIFER
Middle Name:BETH
Last Name:LASKER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8430 UNIVERSITY EXEC PARK DR
Mailing Address - Street 2:SUITE 655
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-1350
Mailing Address - Country:US
Mailing Address - Phone:704-596-5553
Mailing Address - Fax:704-596-1556
Practice Address - Street 1:8430 UNIVERSITY EXEC PARK DR
Practice Address - Street 2:SUITE 655
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-1350
Practice Address - Country:US
Practice Address - Phone:704-596-5553
Practice Address - Fax:704-596-1556
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0144871041C0700X
NCC0041421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical