Provider Demographics
NPI:1467232173
Name:BOSWORTH, JAY NEWMAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:NEWMAN
Last Name:BOSWORTH
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 LINCOLN PL APT 2A2B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-5800
Mailing Address - Country:US
Mailing Address - Phone:617-697-6771
Mailing Address - Fax:
Practice Address - Street 1:1430 BROADWAY RM 1510
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-3368
Practice Address - Country:US
Practice Address - Phone:347-201-0566
Practice Address - Fax:212-262-2858
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026010103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical