Provider Demographics
NPI:1669644332
Name:SAVE-MUNDRA, JAYA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JAYA
Middle Name:
Last Name:SAVE-MUNDRA
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 1:19 THAMES RD
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-6832
Mailing Address - Country:US
Mailing Address - Phone:585-615-9146
Mailing Address - Fax:585-334-0208
Practice Address - Street 1:1110 ROUTE 55
Practice Address - Street 2:SUITE 201
Practice Address - City:LAGRANGEVILLE
Practice Address - State:NY
Practice Address - Zip Code:12540-5045
Practice Address - Country:US
Practice Address - Phone:585-615-9146
Practice Address - Fax:585-334-0208
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015774103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical