Provider Demographics
NPI:1770090672
Name:RAY, JACKIE D (FAMILY PEER ADVOCATE)
Entity type:Individual
Prefix:
First Name:JACKIE
Middle Name:D
Last Name:RAY
Suffix:
Gender:F
Credentials:FAMILY PEER ADVOCATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MUSTARD ST STE 2000
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14609-6980
Mailing Address - Country:US
Mailing Address - Phone:585-354-3336
Mailing Address - Fax:
Practice Address - Street 1:1 MUSTARD ST STE 2000
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14609-6980
Practice Address - Country:US
Practice Address - Phone:585-354-3336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-02
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor