Provider Demographics
NPI:1386189496
Name:SHEAR, JASON (LMHC-P)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:SHEAR
Suffix:
Gender:M
Credentials:LMHC-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 LAKE ST STE D
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-4937
Mailing Address - Country:US
Mailing Address - Phone:716-410-0164
Mailing Address - Fax:
Practice Address - Street 1:42 LAKE ST STE D
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-4937
Practice Address - Country:US
Practice Address - Phone:716-410-0164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-28
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP92234101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health