Provider Demographics
NPI:1235638859
Name:MANSARAY, JENNIFER LEE (LCSW-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEE
Last Name:MANSARAY
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LEE
Other - Last Name:CRUTTENDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1800 ORLEANS ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21287-0010
Mailing Address - Country:US
Mailing Address - Phone:443-398-2828
Mailing Address - Fax:
Practice Address - Street 1:1280 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-1912
Practice Address - Country:US
Practice Address - Phone:716-662-2040
Practice Address - Fax:716-662-0019
Is Sole Proprietor?:No
Enumeration Date:2018-02-09
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY117488104100000X
MD294391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker