National Provider Identifier
Roseanne Johnson Jackson
Roseanne Johnson Jackson is listed in the NPPES registry with a primary specialty of Mental Health Counselor in Buffalo, NY and a listed phone number of (716) 874-4500.
Profile Overview
- NPI
- 1700116993
- Provider Type
- Individual
- Primary Specialty
- Mental Health Counselor
- Enumeration Date
- January 11, 2010
- Last Updated
- October 17, 2016
Practice Location
- 2128 Elmwood Ave
- Buffalo, NY 14207-1910
Phone: (716) 874-4500
Specialties
- Mental Health Counselor (101YM0800X)
- Mental Health Counselor (101YM0800X)
Full Record
- NPI
- 1700116993
- Entity Type
- Individual
- Last Name
- Jackson
- First Name
- Roseanne
- Middle Name
- Johnson
- Name Prefix
- MS.
- Provider Other Last Name
- Johnson
- Provider Other First Name
- Roseanne
- Provider Other Middle Name
- Lee
- Provider Other Name Prefix Text
- MS.
- Provider Other Last Name Type Code
- 1
- Mailing Street Address
- 2128 Elmwood Ave
- Mailing City
- Buffalo
- Mailing State
- NY
- Mailing ZIP Code
- 14207-1910
- Mailing Country
- US
- Mailing Phone
- (716) 874-4500
- Practice Street Address
- 2128 Elmwood Ave
- Practice City
- Buffalo
- Practice State
- NY
- Practice ZIP Code
- 14207-1910
- Practice Country
- US
- Practice Phone
- (716) 874-4500
- Enumeration Date
- January 11, 2010
- Last Updated
- October 17, 2016
- Sex
- Female
- Sole Proprietor
- No
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Mental Health Counselor (101YM0800X), Mental Health Counselor (101YM0800X)