Provider Demographics
NPI:1548617855
Name:DEGEORGE, JAMIE JOHN (LMHC)
Entity Type:Individual
Prefix:MR
First Name:JAMIE
Middle Name:JOHN
Last Name:DEGEORGE
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 W HUMBOLDT PKWY
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-2604
Mailing Address - Country:US
Mailing Address - Phone:716-710-5151
Mailing Address - Fax:716-883-0687
Practice Address - Street 1:95 W HUMBOLDT PKWY
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-2604
Practice Address - Country:US
Practice Address - Phone:716-710-5151
Practice Address - Fax:716-883-0687
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-17
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001811-01101YM0800X
NY001811101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health