Provider Demographics
NPI:1306196738
Name:HUSSAR BOYLE, JESSICA MARIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:MARIE
Last Name:HUSSAR BOYLE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:JESSICA
Other - Middle Name:MARIE
Other - Last Name:HUSSAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:23 HICKORY RD
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-1347
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:269 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-2726
Practice Address - Country:US
Practice Address - Phone:607-252-6634
Practice Address - Fax:607-203-5720
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-13
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023416103T00000X
NY993174151103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY023416OtherPSYCHOLOGIST LICENSE NUMBER
41401OtherNCSP CERTIFICATION NUMBER
NY993174151OtherSCHOOL PSYCHOLOGIST STATE CERTIFICATION CONTROL NUMBER