Provider Demographics
NPI:1932610318
Name:VUKSANAJ, JACQUELYN (LMHC)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:
Last Name:VUKSANAJ
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:JACQUELYN
Other - Middle Name:
Other - Last Name:DAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MHC
Mailing Address - Street 1:500 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12206-2213
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206-2213
Practice Address - Country:US
Practice Address - Phone:518-435-9931
Practice Address - Fax:518-459-3715
Is Sole Proprietor?:No
Enumeration Date:2017-10-12
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
NY009830-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1477695021Medicaid