Provider Demographics
NPI:1043461197
Name:EDDY, JASON JOSEPH (LMHC)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:JOSEPH
Last Name:EDDY
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-3749
Mailing Address - Country:US
Mailing Address - Phone:315-252-8191
Mailing Address - Fax:
Practice Address - Street 1:228 WOODLAWN AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-3749
Practice Address - Country:US
Practice Address - Phone:315-252-8191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004180101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health