Provider Demographics
NPI:1104977586
Name:FORTH-FINEGAN, JAHN L (PHD,LMHC,NCC, CASAC)
Entity type:Individual
Prefix:DR
First Name:JAHN
Middle Name:L
Last Name:FORTH-FINEGAN
Suffix:
Gender:F
Credentials:PHD,LMHC,NCC, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 N GREECE RD
Mailing Address - Street 2:
Mailing Address - City:HILTON
Mailing Address - State:NY
Mailing Address - Zip Code:14468-8902
Mailing Address - Country:US
Mailing Address - Phone:585-392-5777
Mailing Address - Fax:585-392-3692
Practice Address - Street 1:149 N GREECE RD
Practice Address - Street 2:
Practice Address - City:HILTON
Practice Address - State:NY
Practice Address - Zip Code:14468-8902
Practice Address - Country:US
Practice Address - Phone:585-392-5777
Practice Address - Fax:585-392-3692
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000239101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY143818Medicare UPIN
NYJFO149144Medicare UPIN