Provider Demographics
NPI:1275779688
Name:RICHTER, JESSICA JEAN (DO)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:JEAN
Last Name:RICHTER
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:STONY BROOK PSYCHIATRIC ASSOCIATES
Mailing Address - Street 2:HSC LEVEL 10 ROOM 020
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8101
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:STONY BROOK PSYCHIATRIC ASSOCIATES
Practice Address - Street 2:HSC LEVEL 10 ROOM 020
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8101
Practice Address - Country:US
Practice Address - Phone:631-444-6050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-06
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2512842084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry