Provider Demographics
NPI:1386000313
Name:COTTON, JACQUELINE S (MA MHC)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:S
Last Name:COTTON
Suffix:
Gender:F
Credentials:MA MHC
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:CARMINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:227 THORN AVENUE SPECTRUM HEALTH & HUMAN SERVICES
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127
Mailing Address - Country:US
Mailing Address - Phone:716-662-2040
Mailing Address - Fax:716-662-0019
Practice Address - Street 1:1280 MAIN STREET 3RD FLOOR SPECTRUM HEALTH & HUMAN SERV
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209
Practice Address - Country:US
Practice Address - Phone:716-832-1251
Practice Address - Fax:716-887-3833
Is Sole Proprietor?:No
Enumeration Date:2016-01-06
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY09445101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health