Provider Demographics
NPI:1407901630
Name:TAUSIG-EDWARDS, JEPHTHA (PHD)
Entity Type:Individual
Prefix:
First Name:JEPHTHA
Middle Name:
Last Name:TAUSIG-EDWARDS
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 1:295 CENTRAL PARK W
Mailing Address - Street 2:SUITE 2, OFFICE 1
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-3008
Mailing Address - Country:US
Mailing Address - Phone:212-595-9348
Mailing Address - Fax:
Practice Address - Street 1:295 CENTRAL PARK W
Practice Address - Street 2:SUITE 2, OFFICE 1
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3008
Practice Address - Country:US
Practice Address - Phone:212-595-9348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY68-016753103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist