Active NPI
Jennifer Dickerson, BA
- Peer Specialist
- Wellsville, NY
National Provider Identifier
1659737039
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- License
- NYCPS-P-585
- Practice address
- 41 N Broad St
Wellsville, NY 14895-1224 - Phone
- (607) 333-5138
- Fax
- (585) 593-3907
- NPI assigned
- Jan 14, 2016
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | NYCPS-P-585 | NY | Primary |
Addresses
Primary practice location
41 N Broad St
Wellsville, NY 14895-1224
Mailing address
41 N Broad St
Wellsville, NY 14895-1224
Phone (607) 333-5138
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
- Credentials
- Bachelor of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| NYCPS-P-585 | NY | MD | Peer Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1452729600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1452729600000",
"number": "1659737039",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "41 N BROAD ST",
"city": "WELLSVILLE",
"state": "NY",
"postal_code": "148951224",
"telephone_number": "607-333-5138",
"fax_number": "585-593-3907"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "41 N BROAD ST",
"city": "WELLSVILLE",
"state": "NY",
"postal_code": "148951224",
"telephone_number": "607-333-5138",
"fax_number": "585-593-3907"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DICKERSON",
"first_name": "JENNIFER",
"credential": "BA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-01-14",
"last_updated": "2016-01-14",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "NY",
"license": "NYCPS-P-585",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wellsville, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.