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General NPI Number Information
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NPI Number | 1326443052
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Entity Type | Individual
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Provider Name | JAMISON ROBERT WOOD LMSW, CASAC
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Gender | Male
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Dates
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Enumeration Date | 10/23/2014
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Last Update Date | 04/11/2022
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Provider Practice Location Address
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Address Line | 2 HOMESTEAD DR
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City | CORTLAND
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State | NY
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Zip | 13045-3402
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Country | US
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Telephone | 607-453-4353
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Fax |
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Provider Business Mailing Address
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Address Line | 201 E GREEN ST SUITE 500
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City | ITHACA
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State | NY
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Zip | 14850-5635
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Country | US
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Telephone |
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 110862-01
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License Number State | NY
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