Provider Demographics
NPI:1154446342
Name:JASCOLKY, SANDRA (PHD)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:
Last Name:JASCOLKY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 WALL ST
Mailing Address - Street 2:SUITE 1001
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10005-3601
Mailing Address - Country:US
Mailing Address - Phone:212-363-5763
Mailing Address - Fax:212-363-1651
Practice Address - Street 1:80 WALL ST
Practice Address - Street 2:SUITE 1001
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10005-3601
Practice Address - Country:US
Practice Address - Phone:212-363-5763
Practice Address - Fax:212-363-1651
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010583-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV6B181Medicare ID - Type Unspecified