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General NPI Number Information
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NPI Number | 1104267566
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Entity Type | Individual
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Provider Name | JAMIE LYNN DRISCOLL LCSW
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Gender | Female
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Dates
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Enumeration Date | 07/15/2013
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Last Update Date | 10/31/2022
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Provider Practice Location Address
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Address Line | 65 CORTLAND ST
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City | HOMER
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State | NY
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Zip | 13077-1523
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Country | US
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Telephone | 607-745-2412
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Fax |
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Provider Business Mailing Address
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Address Line | 24 COPELAND AVE
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City | HOMER
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State | NY
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Zip | 13077-1529
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Country | US
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Telephone | 160-775-3161
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 0856581
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License Number State | NY
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