Provider Demographics
NPI:1649581257
Name:MOYNIHAN-EJAIFE, JACOMINA ESE (MA, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:JACOMINA
Middle Name:ESE
Last Name:MOYNIHAN-EJAIFE
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 HARVARD ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-2607
Mailing Address - Country:US
Mailing Address - Phone:585-210-8711
Mailing Address - Fax:
Practice Address - Street 1:18 HARVARD ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-2607
Practice Address - Country:US
Practice Address - Phone:585-210-8711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-29
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NY005688101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health