Provider Demographics
NPI:1982850681
Name:PRUIETT, JAY W (LCSW-R)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:W
Last Name:PRUIETT
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 PITTSFORD PALMYRA ROAD
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-3503
Mailing Address - Country:US
Mailing Address - Phone:585-350-8900
Mailing Address - Fax:585-625-3500
Practice Address - Street 1:95 ALLENS CREEK RD STE 232
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-3249
Practice Address - Country:US
Practice Address - Phone:585-350-8900
Practice Address - Fax:585-625-3500
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY075661101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400054268/GJ1000442Medicare PIN
NYJ400054263/GR70008AMedicare PIN