Provider Demographics
NPI:1689936668
Name:LIVINGSTON, JED A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JED
Middle Name:A
Last Name:LIVINGSTON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 CLERMONT AVE
Mailing Address - Street 2:APT. #6O
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-3316
Mailing Address - Country:US
Mailing Address - Phone:917-582-9020
Mailing Address - Fax:
Practice Address - Street 1:171 CLERMONT AVE
Practice Address - Street 2:APT. #6O
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-3316
Practice Address - Country:US
Practice Address - Phone:917-582-9020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP84069103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist