Healthcare Provider Details

I. General information

NPI: 1295037794
Provider Name (Legal Business Name): JILLIAN MARIE KUCSKAR LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JILLIAN MARIE KEMPTER MA

II. Dates (important events)

Enumeration Date: 12/03/2010
Last Update Date: 02/26/2024
Certification Date: 02/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 WELLNESS WAY STE 112
LATHAM NY
12110-2156
US

IV. Provider business mailing address

6 WELLNESS WAY STE 201
LATHAM NY
12110-2156
US

V. Phone/Fax

Practice location:
  • Phone: 518-881-1109
  • Fax: 518-213-6985
Mailing address:
  • Phone: 518-782-3700
  • Fax: 518-782-3799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number005563
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: