Provider Demographics
NPI:1154571297
Name:HAUCK, JESSE HUGH (LMFT)
Entity type:Individual
Prefix:MR
First Name:JESSE
Middle Name:HUGH
Last Name:HAUCK
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 AUDUBON AVE APT 27E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-6311
Mailing Address - Country:US
Mailing Address - Phone:917-797-3675
Mailing Address - Fax:
Practice Address - Street 1:260 AUDUBON AVE APT 27E
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-6311
Practice Address - Country:US
Practice Address - Phone:917-797-3675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-25
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54004106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist