Provider Demographics
NPI:1760060792
Name:KROHN, JESSICA L (LMSW, CASAC-T)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:L
Last Name:KROHN
Suffix:
Gender:F
Credentials:LMSW, CASAC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116A CLAYTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850
Mailing Address - Country:US
Mailing Address - Phone:607-754-1101
Mailing Address - Fax:607-754-1107
Practice Address - Street 1:116A CLAYTON AVE
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-2430
Practice Address - Country:US
Practice Address - Phone:607-754-1101
Practice Address - Fax:607-754-1102
Is Sole Proprietor?:No
Enumeration Date:2021-03-31
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
NY08651251041C0700X
NY0956711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor