Healthcare Provider Details

I. General information

NPI: 1649581257
Provider Name (Legal Business Name): JACOMINA ESE MOYNIHAN-EJAIFE MA, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2010
Last Update Date: 02/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 HARVARD ST
ROCHESTER NY
14607-2607
US

IV. Provider business mailing address

18 HARVARD ST
ROCHESTER NY
14607-2607
US

V. Phone/Fax

Practice location:
  • Phone: 585-210-8711
  • Fax:
Mailing address:
  • Phone: 585-210-8711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number005688
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: