Provider Demographics
NPI:1659944932
Name:MONAHAN, JASON MATTHEW (PMHNP)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:MATTHEW
Last Name:MONAHAN
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22803
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14692-2803
Mailing Address - Country:US
Mailing Address - Phone:585-259-2084
Mailing Address - Fax:
Practice Address - Street 1:168 S BROOKLYN AVE
Practice Address - Street 2:
Practice Address - City:WELLSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14895-1456
Practice Address - Country:US
Practice Address - Phone:585-259-2084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY511624163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health