Provider Demographics
NPI:1609546167
Name:KRYCHIW, JACQUELINE K (PHD)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:K
Last Name:KRYCHIW
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 FULTON ST APT 205
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-2565
Mailing Address - Country:US
Mailing Address - Phone:908-427-1226
Mailing Address - Fax:
Practice Address - Street 1:60 CUTTERMILL RD
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-3131
Practice Address - Country:US
Practice Address - Phone:516-858-4328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist