Provider Demographics
NPI:1629117478
Name:CRAMER, JAY C (MS LMHP)
Entity Type:Individual
Prefix:MR
First Name:JAY
Middle Name:C
Last Name:CRAMER
Suffix:
Gender:M
Credentials:MS LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3341 S 113TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-4741
Mailing Address - Country:US
Mailing Address - Phone:402-721-1417
Mailing Address - Fax:
Practice Address - Street 1:415 E 23RD ST STE 204
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-2300
Practice Address - Country:US
Practice Address - Phone:402-721-1417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2069101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025097000Medicaid