Provider Demographics
NPI:1205378122
Name:GERMANO-FOKIN, JESSICA (EDD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:GERMANO-FOKIN
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:277 ALEXANDER STREET, SUITE 306
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607
Mailing Address - Country:US
Mailing Address - Phone:585-362-7284
Mailing Address - Fax:
Practice Address - Street 1:277 ALEXANDER ST STE 306
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-1941
Practice Address - Country:US
Practice Address - Phone:585-362-7284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-09
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006548101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health