Provider Demographics
NPI:1285039370
Name:JAIKARAN, STACY (MA)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:JAIKARAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 S HIGHLAND AVE APT 4B
Mailing Address - Street 2:
Mailing Address - City:OSSINING
Mailing Address - State:NY
Mailing Address - Zip Code:10562-5837
Mailing Address - Country:US
Mailing Address - Phone:646-262-2235
Mailing Address - Fax:
Practice Address - Street 1:117 S HIGHLAND AVE APT 4B
Practice Address - Street 2:
Practice Address - City:OSSINING
Practice Address - State:NY
Practice Address - Zip Code:10562-5837
Practice Address - Country:US
Practice Address - Phone:646-262-2235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-31
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY885311141103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool