Provider Demographics
NPI:1073002671
Name:FLEMING, JAMIE LYN (LMSW)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYN
Last Name:FLEMING
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 1:206 ALEXANDER AVE
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-3735
Mailing Address - Country:US
Mailing Address - Phone:631-645-2567
Mailing Address - Fax:
Practice Address - Street 1:456 WAVERLY AVE
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-1586
Practice Address - Country:US
Practice Address - Phone:631-447-6460
Practice Address - Fax:631-299-4200
Is Sole Proprietor?:No
Enumeration Date:2018-05-09
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103602-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker