Provider Demographics
NPI:1386239655
Name:BUDINICH, JESSICA REGINA (MHC-LP, CASAC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:REGINA
Last Name:BUDINICH
Suffix:
Gender:F
Credentials:MHC-LP, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 LISA DR
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-2872
Mailing Address - Country:US
Mailing Address - Phone:631-655-7794
Mailing Address - Fax:
Practice Address - Street 1:20 CHURCH ST
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-1926
Practice Address - Country:US
Practice Address - Phone:631-655-7794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health