Provider Demographics
NPI:1518689629
Name:DELLIPIZZI, JAIME
Entity Type:Individual
Prefix:MS
First Name:JAIME
Middle Name:
Last Name:DELLIPIZZI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2873 MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11719-9518
Mailing Address - Country:US
Mailing Address - Phone:163-176-4091
Mailing Address - Fax:
Practice Address - Street 1:2 KATIE DR
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-3565
Practice Address - Country:US
Practice Address - Phone:631-764-0916
Practice Address - Fax:631-874-6300
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY420000014634500Medicaid