Provider Demographics
NPI:1164245759
Name:COLEGROVE, JAMISON LEIGH (LMSW)
Entity type:Individual
Prefix:
First Name:JAMISON
Middle Name:LEIGH
Last Name:COLEGROVE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 177
Mailing Address - Street 2:
Mailing Address - City:OWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13827-0177
Mailing Address - Country:US
Mailing Address - Phone:607-687-4000
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 177
Practice Address - Street 2:
Practice Address - City:OWEGO
Practice Address - State:NY
Practice Address - Zip Code:13827-0177
Practice Address - Country:US
Practice Address - Phone:607-687-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1242441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical