Provider Demographics
NPI:1952627994
Name:BIRMINGHAM, R. JANE
Entity Type:Individual
Prefix:MS
First Name:R.
Middle Name:JANE
Last Name:BIRMINGHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:R.
Other - Middle Name:JANE
Other - Last Name:BIRMINGHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BHC LIC
Mailing Address - Street 1:350 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-3702
Mailing Address - Country:US
Mailing Address - Phone:845-334-7805
Mailing Address - Fax:845-339-2875
Practice Address - Street 1:350 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-3702
Practice Address - Country:US
Practice Address - Phone:845-334-7805
Practice Address - Fax:845-339-2875
Is Sole Proprietor?:No
Enumeration Date:2010-04-15
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000773-1101Y00000X
NY002545-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor