Provider Demographics
NPI:1184856775
Name:TACKABERRY, JESSICA SHARP (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:SHARP
Last Name:TACKABERRY
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 ALEXANDER ST.
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607
Mailing Address - Country:US
Mailing Address - Phone:585-922-7756
Mailing Address - Fax:585-922-7246
Practice Address - Street 1:224 ALEXANDER ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-4000
Practice Address - Country:US
Practice Address - Phone:585-922-7756
Practice Address - Fax:585-922-7246
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-14
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000763106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist