Healthcare Provider Details
I. General information
NPI: 1063810075
Provider Name (Legal Business Name): JERICA JALANE BARBER LMHC, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 12/08/2014
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:
III. Provider practice location address
300 INTERNATIONAL DR SUITE 117
WILLIAMSVILLE NY
14221-5781
US
IV. Provider business mailing address
300 INTERNATIONAL DR STE 100
WILLIAMSVILLE NY
14221-5783
US
V. Phone/Fax
- Phone: 585-343-1681
- Fax: 208-361-8666
- Phone: 716-406-4246
- Fax: 208-361-8666
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 101YA0400X |
| Taxonomy | Addiction (Substance Use Disorder) Counselor |
| License Number | 18 006357 |
| License Number State | NY |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 101YM0800X |
| Taxonomy | Mental Health Counselor |
| License Number | 18 006357 |
| License Number State | NY |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 101YP1600X |
| Taxonomy | Pastoral Counselor |
| License Number | 18 006357 |
| License Number State | NY |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163W00000X |
| Taxonomy | Registered Nurse |
| License Number | 22 537485 |
| License Number State | NY |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WA0400X |
| Taxonomy | Addiction (Substance Use Disorder) Registered Nurse |
| License Number | 22 537485 |
| License Number State | NY |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WA2000X |
| Taxonomy | Administrator Registered Nurse |
| License Number | 22 537485 |
| License Number State | NY |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WC1500X |
| Taxonomy | Community Health Registered Nurse |
| License Number | 22 537485 |
| License Number State | NY |
| # 8 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WC1600X |
| Taxonomy | Continuing Education/Staff Development Registered Nurse |
| License Number | 22 537485 |
| License Number State | NY |
| # 9 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WG0000X |
| Taxonomy | General Practice Registered Nurse |
| License Number | 22 537485 |
| License Number State | NY |
| # 10 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WH0200X |
| Taxonomy | Home Health Registered Nurse |
| License Number | 22 537485 |
| License Number State | NY |
| # 11 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WL0100X |
| Taxonomy | Lactation Consultant (Registered Nurse) |
| License Number | 22 537485 |
| License Number State | NY |
| # 12 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WP0807X |
| Taxonomy | Child & Adolescent Psychiatric/Mental Health Registered Nurse |
| License Number | 22 537485 |
| License Number State | NY |
| # 13 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WP0809X |
| Taxonomy | Adult Psychiatric/Mental Health Registered Nurse |
| License Number | 22 537485 |
| License Number State | NY |
| # 14 | |
| Primary Taxonomy | N |
| Taxonomy Code | 374K00000X |
| Taxonomy | Religious Nonmedical Practitioner |
| License Number | 18 006357 |
| License Number State | NY |
| # 15 | |
| Primary Taxonomy | N |
| Taxonomy Code | 222Q00000X |
| Taxonomy | Developmental Therapist |
| License Number | 18 006357 |
| License Number State | NY |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
