Provider Demographics
NPI:1104102284
Name:KENYON, JAMIE L (LMHC)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:L
Last Name:KENYON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1655 ELMWOOD AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-3429
Mailing Address - Country:US
Mailing Address - Phone:585-319-4547
Mailing Address - Fax:585-319-4547
Practice Address - Street 1:1655 ELMWOOD AVENUE
Practice Address - Street 2:SUITE 202
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620
Practice Address - Country:US
Practice Address - Phone:585-319-4547
Practice Address - Fax:585-319-4547
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-02
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4900101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health