Provider Demographics
NPI:1629452867
Name:ATLAS, JEFFREY (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:ATLAS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:SLEEPY HOLLOW
Mailing Address - State:NY
Mailing Address - Zip Code:10591-2218
Mailing Address - Country:US
Mailing Address - Phone:718-525-7533
Mailing Address - Fax:
Practice Address - Street 1:5 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:SLEEPY HOLLOW
Practice Address - State:NY
Practice Address - Zip Code:10591-2218
Practice Address - Country:US
Practice Address - Phone:718-525-7533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008718-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical