Provider Demographics
NPI:1326067653
Name:NAIDICH, JENNIFER BETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:BETH
Last Name:NAIDICH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11703 BARBERRY CT
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142-8310
Mailing Address - Country:US
Mailing Address - Phone:917-518-0552
Mailing Address - Fax:
Practice Address - Street 1:11703 BARBERRY CT
Practice Address - Street 2:
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142-8310
Practice Address - Country:US
Practice Address - Phone:917-518-0552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0133631103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist