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General NPI Number Information
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NPI Number | 1457824245
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Entity Type | Individual
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Provider Name | JAMIE LYN PETERSON
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Gender | Female
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Dates
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Enumeration Date | 01/04/2019
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Last Update Date | 01/04/2019
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Provider Practice Location Address
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Address Line | 70 JEWETT PKWY
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City | BUFFALO
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State | NY
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Zip | 14214-2322
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Country | US
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Telephone | 716-328-8937
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Fax | 716-533-4301
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Provider Business Mailing Address
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Address Line | 4271 ROXBURY DR
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City | BUFFALO
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State | NY
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Zip | 14221-7632
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Country | US
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Telephone | 716-533-0136
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 006613-1
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License Number State | NY
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