Provider Demographics
NPI:1205001427
Name:KWAWER, JAY S (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:S
Last Name:KWAWER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 W END AVE
Mailing Address - Street 2:SUITE 1-E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-4330
Mailing Address - Country:US
Mailing Address - Phone:212-799-3083
Mailing Address - Fax:815-366-9081
Practice Address - Street 1:490 W END AVE
Practice Address - Street 2:SUITE 1-E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-4330
Practice Address - Country:US
Practice Address - Phone:212-799-3083
Practice Address - Fax:815-366-9081
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4237103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist