=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205543188
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMIE CARR LMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2022
-----------------------------------------------------
Last Update Date | 11/01/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 85 S UNION ST
-----------------------------------------------------
City | SPENCERPORT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14559-1255
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-524-1221
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 59 CEDAR TER
-----------------------------------------------------
City | HILTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14468-1445
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-727-8115
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 001642
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------