Provider Demographics
NPI:1053539247
Name:STORCH, JENNIFER (LMHC, CASAC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:STORCH
Suffix:
Gender:F
Credentials:LMHC, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7353 STATE ROUTE 96
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564-9788
Mailing Address - Country:US
Mailing Address - Phone:585-410-4861
Mailing Address - Fax:
Practice Address - Street 1:7353 STATE ROUTE 96
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-9788
Practice Address - Country:US
Practice Address - Phone:585-410-4861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005407101YM0800X
NY25457101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)