Provider Demographics
NPI:1659596625
Name:OKIE, JEAN EDITH (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:EDITH
Last Name:OKIE
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 1:51 PROSPECT PL
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-2801
Mailing Address - Country:US
Mailing Address - Phone:718-398-1657
Mailing Address - Fax:718-398-1659
Practice Address - Street 1:142 JORALEMON ST
Practice Address - Street 2:SUITE 9A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4709
Practice Address - Country:US
Practice Address - Phone:718-855-3365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011256103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01884844Medicaid
NY01884844Medicaid