Individual
JENNIFER LYNN VIDALON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
3602 14TH ST, LONG ISLAND CITY, NY 11106-4704
(718) 392-2510
(718) 392-2637
Mailing address
3602 14TH ST, LONG ISLAND CITY, NY 11106-4704
(718) 392-2510
(718) 392-2637
Taxonomy
Speciality
Code
Description
License number
State
1041S0200X
School Social Worker
Primary
080538
NY
Other
Enumeration date
07/12/2012
Last updated
07/12/2012
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