Provider Demographics
NPI:1548094592
Name:FOUNTAIN, JAIMIE LYNNE (LMSW, LMHC)
Entity type:Individual
Prefix:
First Name:JAIMIE
Middle Name:LYNNE
Last Name:FOUNTAIN
Suffix:
Gender:F
Credentials:LMSW, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 JUNE DR
Mailing Address - Street 2:
Mailing Address - City:ELMA
Mailing Address - State:NY
Mailing Address - Zip Code:14059-9203
Mailing Address - Country:US
Mailing Address - Phone:716-864-7052
Mailing Address - Fax:
Practice Address - Street 1:6350 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5821
Practice Address - Country:US
Practice Address - Phone:716-783-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health