Provider Demographics
NPI:1770810608
Name:DUNSTAN, JILL MARIE (LMHC, CASAC)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:MARIE
Last Name:DUNSTAN
Suffix:
Gender:F
Credentials:LMHC, CASAC
Other - Prefix:MISS
Other - First Name:JILL
Other - Middle Name:MARIE
Other - Last Name:IZYDORCZAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHC, CASAC
Mailing Address - Street 1:190 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-4349
Mailing Address - Country:US
Mailing Address - Phone:716-474-4400
Mailing Address - Fax:
Practice Address - Street 1:190 SUNSET DR
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-4349
Practice Address - Country:US
Practice Address - Phone:716-474-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-13
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20452101YA0400X
NYCASAC-20452101YA0400X
NYLMHC-004391101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)