Provider Demographics
NPI:1942612809
Name:SUK, JEANNINE DEJOSEPH (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:JEANNINE
Middle Name:DEJOSEPH
Last Name:SUK
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1659 AMHERST ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-2029
Mailing Address - Country:US
Mailing Address - Phone:716-207-2441
Mailing Address - Fax:
Practice Address - Street 1:1659 AMHERST ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-2029
Practice Address - Country:US
Practice Address - Phone:716-207-2441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-27
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001871101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health