Basic Information
| Provider Information | |||||||||
| NPI: | 1194041673 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WELLS | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | C. | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LCSW-R | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 FOREST AVENUE | ||||||||
| Address2: | BPC - BUTLER CLINIC | ||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168162445 | ||||||||
| FaxNumber: | 7168162547 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 FOREST AVE | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142131207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168162445 | ||||||||
| FaxNumber: | 7168162547 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2010 | ||||||||
| LastUpdateDate: | 04/09/2010 | ||||||||
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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 | 1041C0700X | R057929-1 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.