Provider Demographics
NPI:1013646785
Name:PLOTNICK, JENNA LEAHANN (PSYD)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:LEAHANN
Last Name:PLOTNICK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 BROWN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19123-2106
Mailing Address - Country:US
Mailing Address - Phone:301-806-7117
Mailing Address - Fax:
Practice Address - Street 1:22 N PENNELL RD
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-5520
Practice Address - Country:US
Practice Address - Phone:267-551-1984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist