Provider Demographics
NPI:1699556233
Name:HAMMILL, JENELLE (LMHC)
Entity type:Individual
Prefix:
First Name:JENELLE
Middle Name:
Last Name:HAMMILL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:JENELLE
Other - Middle Name:
Other - Last Name:KALIES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:330 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202-1868
Mailing Address - Country:US
Mailing Address - Phone:716-954-1041
Mailing Address - Fax:
Practice Address - Street 1:330 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-1868
Practice Address - Country:US
Practice Address - Phone:716-954-1041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007855-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health