Provider Demographics
NPI:1508806688
Name:JONES, ANNIE LEE (PHD)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:LEE
Last Name:JONES
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 1:8675 MIDLAND PKWY
Mailing Address - Street 2:APT. 5J
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-3049
Mailing Address - Country:US
Mailing Address - Phone:718-297-4883
Mailing Address - Fax:
Practice Address - Street 1:8786 188TH ST
Practice Address - Street 2:HOLLIS
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11423-1131
Practice Address - Country:US
Practice Address - Phone:718-658-4648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005988103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical