Provider Demographics
NPI:1730583238
Name:SOBER, JENNIFER (LCSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:SOBER
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 1:80 SCOTT AVE
Mailing Address - Street 2:CASTLETON ELEMENTARY SCHOOL
Mailing Address - City:CASTLETON ON HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:12033-1336
Mailing Address - Country:US
Mailing Address - Phone:518-732-7755
Mailing Address - Fax:518-732-0495
Practice Address - Street 1:80 SCOTT AVE
Practice Address - Street 2:CASTLETON ELEMENTARY SCHOOL
Practice Address - City:CASTLETON ON HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12033-1336
Practice Address - Country:US
Practice Address - Phone:518-732-7755
Practice Address - Fax:518-732-0495
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-14
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY08243011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical