Provider Demographics
NPI:1992417109
Name:HUSSEY, YEZENIA MARIE (LMHC)
Entity type:Individual
Prefix:
First Name:YEZENIA
Middle Name:MARIE
Last Name:HUSSEY
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 1:1343 LONG POND RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-2913
Mailing Address - Country:US
Mailing Address - Phone:585-371-6464
Mailing Address - Fax:
Practice Address - Street 1:1100 LONG POND RD STE 111
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-1179
Practice Address - Country:US
Practice Address - Phone:585-371-6464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18-P112134-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY18-P112134-01OtherPERMIT