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NPI Code Detail

MEDICARE: JWS LICENSED MARRIAGE AND FAMILY THERAPIST, PC

MEDICARE: JWS LICENSED MARRIAGE AND FAMILY THERAPIST, PC
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
1106H00000XMarriage & Family Therapist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1255895892
Entity Type Code : Organization
Provider Name (Legal Business Name) : JWS LICENSED MARRIAGE AND FAMILY THERAPIST, PC
Provider Business Mailing Address
First Line : 70 W GENESEE ST
Second Line :
City : BALDWINSVILLE
State : NY
Zip : 13027-1145
Country : US
Telephone Number : 315-857-3035
Fax Number : 315-720-1171
Provider Business Practice Location Address
First Line : 3070 BELGIUM RD
Second Line :
City : BALDWINSVILLE
State : NY
Zip : 13027-9546
Country : US
Telephone Number : 315-857-3035
Fax Number : 315-720-1171
Authorized Official
Title or Position : OWNER
Name : JENNIFER LYNN WAINMAN-SAUDA
Credential : LMFT
Telephone Number : 315-857-3035
Provider Enumeration Date : 01/28/2019
Last Update Date : 03/13/2020

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