Provider Demographics
NPI:1326599762
Name:NYSENBAUM, JESSICA JANKOWSKI (PHD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:JANKOWSKI
Last Name:NYSENBAUM
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 1:6312 CAMEO CT
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3548
Mailing Address - Country:US
Mailing Address - Phone:773-443-9143
Mailing Address - Fax:
Practice Address - Street 1:6931 ARLINGTON RD STE 309
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-5285
Practice Address - Country:US
Practice Address - Phone:773-443-9143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-20
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSYA00099102L00000X
MD06061103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst