Provider Demographics
NPI:1063267706
Name:PURNELL, JOVIAN ETTORE (PHD)
Entity type:Individual
Prefix:DR
First Name:JOVIAN
Middle Name:ETTORE
Last Name:PURNELL
Suffix:
Gender:U
Credentials:PHD
Other - Prefix:DR
Other - First Name:JAE
Other - Middle Name:
Other - Last Name:PURNELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:418 E 71ST ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4892
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:418 E 71ST ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4892
Practice Address - Country:US
Practice Address - Phone:347-201-0155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-17
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026242-01103TC0700X
NY026242103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical