Active NPI
Christie Jacques
- Mental Health Counselor
- Pomona, NY
National Provider Identifier
1003547183
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 00455
- Practice address
- 165 Richard CT
Pomona, NY 10970-2307 - Phone
- (845) 642-2566
- NPI assigned
- Jun 21, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 37PC00598400 | NJ | |
| Mental Health Counselor | 101YM0800X | 00455 | NY | Primary |
Addresses
Primary practice location
165 Richard CT
Pomona, NY 10970-2307
Mailing address
165 Richard CT
Pomona, NY 10970-2307
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00455 | NY | MD | Mental Health Counselor |
| 37PC00598400 | NJ | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1655769600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1655769600000",
"number": "1003547183",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "165 RICHARD CT",
"city": "POMONA",
"state": "NY",
"postal_code": "109702307"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "165 RICHARD CT",
"city": "POMONA",
"state": "NY",
"postal_code": "109702307",
"telephone_number": "845-642-2566"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACQUES",
"first_name": "CHRISTIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-06-21",
"last_updated": "2022-06-21",
"certification_date": "2022-06-21",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NJ",
"license": "37PC00598400",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NY",
"license": "00455",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pomona, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.