Provider Demographics
NPI:1558617233
Name:CROSS, JOHN JEROME (BA)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:JEROME
Last Name:CROSS
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14209-1988
Mailing Address - Country:US
Mailing Address - Phone:716-881-2591
Mailing Address - Fax:716-881-0652
Practice Address - Street 1:1325 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-1988
Practice Address - Country:US
Practice Address - Phone:716-881-2591
Practice Address - Fax:716-881-0652
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health