Provider Demographics
NPI:1407926611
Name:HARTSTEIN, JENNIFER L (PSYD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:HARTSTEIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 W 25TH ST
Mailing Address - Street 2:SIXTH FLOOR, SUITE 5
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-7405
Mailing Address - Country:US
Mailing Address - Phone:212-561-9727
Mailing Address - Fax:212-591-6483
Practice Address - Street 1:138 W 25TH ST
Practice Address - Street 2:SIXTH FLOOR, SUITE 5
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-7405
Practice Address - Country:US
Practice Address - Phone:212-561-9727
Practice Address - Fax:212-591-6483
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016421103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent