JACKIE D RAY (NPI# 1770090672) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770090672 |
| Entity Type | Individual |
| Full Name | JACKIE D RAY |
| Credential | FAMILY PEER ADVOCATE |
| Practice Address |
1 Mustard St Ste 2000 Rochester NY 14609-6980 |
| Practice Telephone | 5853543336 |
| Mailing Telephone | 5853543336 |
| Enumeration Date | 2018-01-02 |
| Last Update Date | 2018-01-02 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101Y00000X | Counselor | Behavioral Health & Social Service Providers | ||
| Y | 175T00000X | Peer Specialist | Other Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962866152 | Jackie Ray Jr. | Physician Assistant | 2007 Megan Ct, Wylie, TX 75098 | 2016-04-13 |
| Street Address |
1 MUSTARD ST STE 2000 |
| City | ROCHESTER |
| State | NY |
| Zip Code | 14609-6980 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285141184 | Rebecca Rose | Counselor | 1 Mustard St Ste 2000, Rochester, NY 14609-6980 | 2018-01-02 |
| 1033745286 | Kathleen Hamell | Case Manager/Care Coordinator | 1 Mustard St Ste 2000, Rochester, NY 14609-6980 | 2020-03-19 |
| 1588131932 | Carol A Tirado | Case Manager/Care Coordinator | 1 Mustard St Ste 2000, Rochester, NY 14609-6980 | 2018-10-24 |
| 1083121586 | Laura Danielle Mercier | Counselor | 1 Mustard St Ste 2000, Rochester, NY 14609-6980 | 2018-01-05 |
| 1063929974 | Christina Rose Digiorgio | Case Manager/Care Coordinator | 1 Mustard St Ste 2000, Rochester, NY 14609-6980 | 2018-01-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154928828 | Aundrea Camille Williams | Licensed Practical Nurse | 99 Meaodw Circle, Rochester, NY 14609 | 2020-10-06 |
| 1043836869 | Sharon Ann Reilly | Registered Nurse | 910 North Goodman Street, Suite 1, Rochester, NY 14609 | 2020-06-17 |
| 1235655671 | Tameka Shaunte Parker | Licensed Practical Nurse | 35 Village Way, Rochester, NY 14609 | 2017-08-17 |
| 1851817472 | Mary Ann Dukes | Registered Nurse | 75 Yates Street, Rochester, NY 14609 | 2017-08-15 |
| 1023533064 | Fernando Caumont | Urology | 2615 Culver Rd Ste 100, Rochester, NY 14609 | 2017-08-10 |
| 1083061162 | Teyanee Latavia Harewood | Registered Nurse | 418 Hayward Ave, Rochester, NY 14609 | 2016-05-19 |
| 1164853891 | Sukhminder Kaur Sahansra | Internal Medicine | 335 North Park Drive, Elderone, Rochester, NY 14609 | 2013-12-05 |
| 1952749863 | Nada Jadrovska | Registered Nurse | 79 Eagle Rock Dr, Rochester, NY 14609 | 2013-06-13 |
| 1457602930 | Lynnetta Maria Hollomon | Licensed Practical Nurse | 827 Edgecreek Trail, Rochester, NY 14609 | 2012-09-25 |
| 1568711596 | Anthony L. Jordan Health Corporation | Clinic/Center | 151 Parsells Ave, Jordan Health At Community Place, Rochester, NY 14609 | 2012-09-06 |
| Find all providers in zip 14609 | ||||
| Taxonomy Code | 175T00000X |
| Grouping | Other Service Providers |
| Classification | Peer Specialist |
| Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority. |
| Notes: Source: National Uniform Claim Committee [7/1/2014: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467064832 | Kenneth Robert Lewis | Peer Specialist | 320 N Goodman St Ste 202320, Rochester, NY 14607-1185 | 2020-08-18 |
| 1487292793 | Robert Lee | Peer Specialist | 835 West Main St, Rochester, NY 14611-2335 | 2019-12-17 |
| 1811534670 | Christopher J Clase | Peer Specialist | 3 Stonewood Park Apt D, Rochester, NY 14616-3628 | 2019-11-28 |
| 1467011320 | Vinnie Dunnell Williams | Peer Specialist | 73 Brookfield Rd, Rochester, NY 14610-1015 | 2019-06-13 |
| 1881185122 | Tammy J Demarle | Peer Specialist | 320 N Goodman St Ste 202, Rochester, NY 14607-1186 | 2018-05-22 |
| 1912497223 | Lorrie Boyce | Peer Specialist | 344 N Goodman St, Rochester, NY 14607-1146 | 2018-05-11 |
| 1366948424 | Monekia Michelle Moore | Peer Specialist | 320 North Goodman Street, Rochester, NY 14607 | 2018-04-05 |
| 1366950164 | Tina Amico | Peer Specialist | 687 Lee Rd Ste 185c, Rochester, NY 14606-4258 | 2018-01-15 |
| 1982211850 | Sharon Thaxton | Peer Specialist | 835 W Main St, Rochester, NY 14611-2335 | 2020-09-25 |
| 1932710308 | Megan B Smith | Peer Specialist | 1 Mustard St, Rochester, NY 14609-6980 | 2020-08-11 |
| Find all providers in ROCHESTER | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.