Provider Demographics
NPI:1831306182
Name:JANICKI, JEFFREY JOHN (MS, NCC, LMHC)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:JOHN
Last Name:JANICKI
Suffix:
Gender:M
Credentials:MS, NCC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 BREWER PL
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14787-1313
Mailing Address - Country:US
Mailing Address - Phone:716-793-4775
Mailing Address - Fax:716-673-3140
Practice Address - Street 1:17 BREWER PL
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NY
Practice Address - Zip Code:14787-1313
Practice Address - Country:US
Practice Address - Phone:716-793-4775
Practice Address - Fax:716-673-3140
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000630101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health