Provider Demographics
NPI:1558853911
Name:TAYLOR, JENNIFER (PSYD)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 CAROL PL
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10303-2124
Mailing Address - Country:US
Mailing Address - Phone:718-915-4060
Mailing Address - Fax:718-983-5320
Practice Address - Street 1:48 CAROL PL
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10303-2124
Practice Address - Country:US
Practice Address - Phone:718-915-4060
Practice Address - Fax:718-983-5320
Is Sole Proprietor?:No
Enumeration Date:2018-06-01
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor