Provider Demographics
NPI:1578353728
Name:JONES, RETHA NICHOLE (CASAC-T)
Entity type:Individual
Prefix:
First Name:RETHA
Middle Name:NICHOLE
Last Name:JONES
Suffix:
Gender:F
Credentials:CASAC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 LEONARD ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-2316
Mailing Address - Country:US
Mailing Address - Phone:716-254-7210
Mailing Address - Fax:
Practice Address - Street 1:68 LEONARD ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-2316
Practice Address - Country:US
Practice Address - Phone:716-254-7210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-10
Last Update Date:2025-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY40380101YA0400X
171400000X, 171M00000X, 172V00000X, 174V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171400000XOther Service ProvidersHealth & Wellness Coach
No172V00000XOther Service ProvidersCommunity Health Worker
No174V00000XOther Service ProvidersClinical Ethicist