Provider Demographics
NPI:1093137598
Name:GHAMAR, JACLYN (PSYD)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:GHAMAR
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 1:233 E 70TH ST
Mailing Address - Street 2:8P
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5223
Mailing Address - Country:US
Mailing Address - Phone:516-458-9177
Mailing Address - Fax:
Practice Address - Street 1:233 E 70TH ST
Practice Address - Street 2:8P
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5223
Practice Address - Country:US
Practice Address - Phone:516-458-9177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-17
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020427103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY020427OtherPSYCHOLOGIST LICENSE