Provider Demographics
NPI:1518242999
Name:SPIEGEL, JESSE BARON (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:BARON
Last Name:SPIEGEL
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 1:37 W 26TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-1006
Mailing Address - Country:US
Mailing Address - Phone:212-696-1550
Mailing Address - Fax:212-696-1602
Practice Address - Street 1:1964 WESTWOOD BLVD STE 310
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-8422
Practice Address - Country:US
Practice Address - Phone:310-775-2112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-17
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP03405103T00000X
CA29913103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02850677Medicaid