Healthcare Provider Details

I. General information

NPI: 1760060792
Provider Name (Legal Business Name): JESSICA L KROHN LMSW, CASAC-T
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116A CLAYTON AVE
VESTAL NY
13850-2430
US

IV. Provider business mailing address

101 CASTLE CREEK RD
BINGHAMTON NY
13901-1005
US

V. Phone/Fax

Practice location:
  • Phone: 607-754-1101
  • Fax: 607-754-1102
Mailing address:
  • Phone: 607-444-2850
  • Fax: 877-552-1301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0865125
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number095671
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: