Provider Demographics
NPI:1023687456
Name:AOUAD, JESSICA TRUMAN (MS ED, LMHC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:TRUMAN
Last Name:AOUAD
Suffix:
Gender:F
Credentials:MS ED, LMHC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:E
Other - Last Name:TRUMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3306 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ENDWELL
Mailing Address - State:NY
Mailing Address - Zip Code:13760-5955
Mailing Address - Country:US
Mailing Address - Phone:657-345-5868
Mailing Address - Fax:607-766-5594
Practice Address - Street 1:15 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-2742
Practice Address - Country:US
Practice Address - Phone:657-345-5868
Practice Address - Fax:607-766-5594
Is Sole Proprietor?:No
Enumeration Date:2021-06-21
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011440101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health