Provider Demographics
NPI:1912350786
Name:CRAVE, JENNIFER ANNE (LMHC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANNE
Last Name:CRAVE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ANNE
Other - Last Name:BUSACKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:105 OAK ST
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:NY
Mailing Address - Zip Code:12822-1203
Mailing Address - Country:US
Mailing Address - Phone:518-654-9005
Mailing Address - Fax:
Practice Address - Street 1:105 OAK STREET
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:NY
Practice Address - Zip Code:12822
Practice Address - Country:US
Practice Address - Phone:518-654-9005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-18
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006594-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health