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405 Howard Ave. Jamestown NY 14701-1560 | |
| (724) 396-1510 | |
| (724) 972-4627 |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 405 Howard Ave., Jamestown, New York |
| Authorized Official Name and Position | Alexander R Hoffman (ALEXANDER HOFFMAN) |
| Authorized Official Contact | 7249724627 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
101 Pembroke Ct Greensburg PA 15601-6404 Ph: (724) 396-1510 | 405 Howard Ave. Jamestown NY 14701-1560 Ph: (724) 396-1510 |
| NPI Number | 1457027864 |
|---|---|
| Provider Enumeration Date | 08/17/2021 |
| Last Update Date | 01/13/2025 |
| Certification Date | 01/13/2025 |
| Medicare PECOS PAC ID | 7618137522 |
|---|---|
| Medicare Enrollment ID | O20241115001246 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457027864 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Sandra Lee Hanson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1528727872 PECOS PAC ID: 0143755736 Enrollment ID: I20241119003236 |
| Provider Name | Ned R. Lindstrom |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1073941597 PECOS PAC ID: 1456887249 Enrollment ID: I20241203003746 |
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