Provider Demographics
NPI:1255895892
Name:JWS LICENSED MARRIAGE AND FAMILY THERAPIST, PC
Entity type:Organization
Organization Name:JWS LICENSED MARRIAGE AND FAMILY THERAPIST, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WAINMAN-SAUDA
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:315-857-3035
Mailing Address - Street 1:70 W GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-1145
Mailing Address - Country:US
Mailing Address - Phone:315-857-3035
Mailing Address - Fax:315-720-1171
Practice Address - Street 1:3070 BELGIUM RD
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-9546
Practice Address - Country:US
Practice Address - Phone:315-857-3035
Practice Address - Fax:315-720-1171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-28
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1659458563Medicaid