Basic Information
| Provider Information | |||||||||
| NPI: | 1144579251 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JALIL-CONTRERAS | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | |||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 741 DELAWARE AVENUE | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7162181400 | ||||||||
| FaxNumber: | 7163322820 | ||||||||
| Practice Location | |||||||||
| Address1: | 33 WILKESBARRE AVENUE | ||||||||
| Address2: | |||||||||
| City: | LACKAWANNA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168226877 | ||||||||
| FaxNumber: | 7168271726 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/05/2012 | ||||||||
| LastUpdateDate: | 09/05/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 00076233 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.