Provider Demographics
NPI:1720006265
Name:HOTALING, JENNIFER (PHD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:HOTALING
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 1:23 HELDERVUE AVE
Mailing Address - Street 2:
Mailing Address - City:SLINGERLANDS
Mailing Address - State:NY
Mailing Address - Zip Code:12159-3600
Mailing Address - Country:US
Mailing Address - Phone:518-581-7260
Mailing Address - Fax:518-633-1218
Practice Address - Street 1:56 CLIFTON COUNTRY RD STE 104
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3995
Practice Address - Country:US
Practice Address - Phone:518-581-7260
Practice Address - Fax:518-633-1218
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014917103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02757055Medicaid