Provider Demographics
NPI:1942717541
Name:VICKERY, JENNIFER W CRANE (LCSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:W CRANE
Last Name:VICKERY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:732 ROYAL SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-2566
Mailing Address - Country:US
Mailing Address - Phone:585-317-7328
Mailing Address - Fax:
Practice Address - Street 1:732 ROYAL SUNSET DR
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-2566
Practice Address - Country:US
Practice Address - Phone:585-317-7328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-04
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0770651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical