Provider Demographics
NPI:1215390240
Name:MICCIULLI, JESSICA COHEN (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:COHEN
Last Name:MICCIULLI
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:COHEN
Other - Last Name:OCHERET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:1211 STEWART AVE.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714
Mailing Address - Country:US
Mailing Address - Phone:516-465-3998
Mailing Address - Fax:212-531-3431
Practice Address - Street 1:1211 STEWART AVE.
Practice Address - Street 2:SUITE 100
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714
Practice Address - Country:US
Practice Address - Phone:516-465-3998
Practice Address - Fax:212-531-3431
Is Sole Proprietor?:No
Enumeration Date:2016-03-29
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006998-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health