Basic Information
| Provider Information | |||||||||
| NPI: | 1699340026 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REESE | ||||||||
| FirstName: | JULIANNE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 140 PINE STREET | ||||||||
| Address2: | |||||||||
| City: | HAMBURG | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14075 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 140 PINE STREET | ||||||||
| Address2: | |||||||||
| City: | HAMBURG | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14075 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166464991 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2021 | ||||||||
| LastUpdateDate: | 07/27/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 05/27/2021 | ||||||||
| NPIReactivationDate: | 06/18/2021 | ||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | NY | N | Behavioral Health & Social Service Providers | Counselor | 104100000X | S.2207377 | OH | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.