Provider Demographics
NPI:1710617329
Name:MOHLMAN, JAN
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:
Last Name:MOHLMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 CABRINI BLVD APT 33
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-3432
Mailing Address - Country:US
Mailing Address - Phone:917-334-1274
Mailing Address - Fax:
Practice Address - Street 1:140 CABRINI BLVD APT 33
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-3432
Practice Address - Country:US
Practice Address - Phone:917-334-1274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015192-1103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral