Provider Demographics
NPI:1528589223
Name:JASON DUNCAN LLC
Entity Type:Organization
Organization Name:JASON DUNCAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE AND MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:914-447-8986
Mailing Address - Street 1:7 BALINT DR APT 516
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-3928
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:60 E 42ND ST STE 4600
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10165-0006
Practice Address - Country:US
Practice Address - Phone:914-447-8986
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-03
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021732103TC0700X, 103TF0200X
CT003659103TC0700X
WAPY60602588103TC0700X
NC4876103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Single Specialty