Provider Demographics
NPI:1033712757
Name:PAPATHOMOPOULOS, JAMIE DEE (LMSW)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:DEE
Last Name:PAPATHOMOPOULOS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 E EDWARDS ST
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-6007
Mailing Address - Country:US
Mailing Address - Phone:607-644-0874
Mailing Address - Fax:
Practice Address - Street 1:314 E EDWARDS ST
Practice Address - Street 2:
Practice Address - City:ENDICOTT
Practice Address - State:NY
Practice Address - Zip Code:13760-6007
Practice Address - Country:US
Practice Address - Phone:607-644-0874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY108373101YM0800X
NY31408101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health