Provider Demographics
NPI:1053123885
Name:SOVIK, JENNIFER BAUER (LMSW)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:BAUER
Last Name:SOVIK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:HORSEHEADS
Mailing Address - State:NY
Mailing Address - Zip Code:14845-2254
Mailing Address - Country:US
Mailing Address - Phone:607-200-3433
Mailing Address - Fax:
Practice Address - Street 1:902 W BROAD ST
Practice Address - Street 2:
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845-2254
Practice Address - Country:US
Practice Address - Phone:607-247-1442
Practice Address - Fax:607-213-3154
Is Sole Proprietor?:No
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
NY126348-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor