MEDICARE: JACLYNE ELIZABETH NEWTON LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	022196	NY
2	101YM0800X	Mental Health Counselor	012196	NY
3	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1497303481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACLYNE ELIZABETH NEWTON LMHC

Provider Business Mailing Address
First Line	:	PO BOX 44
Second Line	:
City	:	GLENFIELD
State	:	NY
Zip	:	13343-0044
Country	:	US
Telephone Number	:	315-681-5019
Fax Number	:	315-222-7313

Provider Business Practice Location Address
First Line	:	6945 AUSTIN RD
Second Line	:
City	:	GLENFIELD
State	:	NY
Zip	:	13343-1914
Country	:	US
Telephone Number	:	315-681-5019
Fax Number	:	315-222-7313

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/03/2019
Last Update Date	:	03/25/2026

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