Provider Demographics
NPI:1235650201
Name:JENNIFER SMITH PSYCHOLOGIST PC
Entity Type:Organization
Organization Name:JENNIFER SMITH PSYCHOLOGIST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:917-355-2031
Mailing Address - Street 1:44 POINT BREEZE AVE
Mailing Address - Street 2:
Mailing Address - City:BREEZY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11697-1621
Mailing Address - Country:US
Mailing Address - Phone:917-355-2031
Mailing Address - Fax:
Practice Address - Street 1:12904 NEWPORT AVE
Practice Address - Street 2:
Practice Address - City:ROCKAWAY PARK
Practice Address - State:NY
Practice Address - Zip Code:11694-1617
Practice Address - Country:US
Practice Address - Phone:347-523-5321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-29
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015747103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty