Provider Demographics
NPI:1598820227
Name:NAUHEIM, JAMIE LYNN (PH D, PC)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:LYNN
Last Name:NAUHEIM
Suffix:
Gender:F
Credentials:PH D, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 ROANOKE AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2778
Mailing Address - Country:US
Mailing Address - Phone:631-727-8270
Mailing Address - Fax:631-369-9423
Practice Address - Street 1:223 ROANOKE AVE
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2778
Practice Address - Country:US
Practice Address - Phone:631-727-8270
Practice Address - Fax:631-369-9423
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007062103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY081842OtherVALUE OPTIONS PROVIDER #
NYV3085OtherWELL CHOICE PROVIDER #