Provider Demographics
NPI:1497878763
Name:GARTNER, JANE ELLEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:ELLEN
Last Name:GARTNER
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 1:552 2ND ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-2608
Mailing Address - Country:US
Mailing Address - Phone:718-499-3231
Mailing Address - Fax:718-499-3231
Practice Address - Street 1:552 2ND ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-2608
Practice Address - Country:US
Practice Address - Phone:718-499-3231
Practice Address - Fax:718-499-3231
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004403-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV50101Medicare ID - Type Unspecified