Provider Demographics
NPI:1689105835
Name:GIFFORD, JESSICA (LMHC, CASAC, NCC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:GIFFORD
Suffix:
Gender:F
Credentials:LMHC, CASAC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5331 ALPINE DR
Mailing Address - Street 2:
Mailing Address - City:HONEOYE
Mailing Address - State:NY
Mailing Address - Zip Code:14471-9622
Mailing Address - Country:US
Mailing Address - Phone:585-259-3892
Mailing Address - Fax:
Practice Address - Street 1:807 RIDGE RD STE 203
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-2497
Practice Address - Country:US
Practice Address - Phone:585-259-3892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-21
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007241-1101YM0800X
NY30647101YA0400X
NY007241101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)