Healthcare Provider Details

I. General information

NPI: 1407082589
Provider Name (Legal Business Name): JENNIFER MCDONALD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2009
Last Update Date: 06/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 S ERIE ST
MAYVILLE NY
14757-1120
US

IV. Provider business mailing address

7 N ERIE ST
MAYVILLE NY
14757-1090
US

V. Phone/Fax

Practice location:
  • Phone: 716-753-4150
  • Fax: 716-753-2906
Mailing address:
  • Phone: 716-753-4318
  • Fax: 716-753-4230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: