Provider Demographics
NPI:1801050646
Name:PFEIFER, JEAN SHARON (LMFT)
Entity type:Individual
Prefix:MS
First Name:JEAN
Middle Name:SHARON
Last Name:PFEIFER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 145
Mailing Address - Street 2:32340 NY RT 12E
Mailing Address - City:CAPE VINCENT
Mailing Address - State:NY
Mailing Address - Zip Code:13618-2100
Mailing Address - Country:US
Mailing Address - Phone:315-501-4040
Mailing Address - Fax:
Practice Address - Street 1:32340 NY RT 12E
Practice Address - Street 2:
Practice Address - City:CAPE VINCENT
Practice Address - State:NY
Practice Address - Zip Code:13618-2100
Practice Address - Country:US
Practice Address - Phone:315-501-4040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000156101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVADOOOOtherUPIN