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NPI Code Detail

MEDICARE: JESSICA WASKOW LMHC

MEDICARE: JESSICA WASKOW LMHC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1255796033
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA WASKOW LMHC
Provider Business Mailing Address
First Line : 52 WOODSTREAM DR
Second Line :
City : GRAND ISLAND
State : NY
Zip : 14072-1485
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 52 WOODSTREAM DR
Second Line :
City : GRAND ISLAND
State : NY
Zip : 14072-1485
Country : US
Telephone Number : 716-302-4545
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/22/2015
Last Update Date : 08/14/2023

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