Healthcare Provider Details

I. General information

NPI: 1700975489
Provider Name (Legal Business Name): LINDA DEJOSEPH CRC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

332 E 4TH ST
JAMESTOWN NY
14701-5502
US

IV. Provider business mailing address

PO BOX 457
JAMESTOWN NY
14702-0457
US

V. Phone/Fax

Practice location:
  • Phone: 716-488-1971
  • Fax: 716-483-6878
Mailing address:
  • Phone: 716-488-1971
  • Fax: 716-483-6878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number032052
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: