Provider Demographics
NPI:1760815161
Name:JARVIS, JULIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:
Last Name:JARVIS
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 1:345 7TH AVE
Mailing Address - Street 2:SUITE 1602
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-5006
Mailing Address - Country:US
Mailing Address - Phone:917-701-8976
Mailing Address - Fax:
Practice Address - Street 1:345 7TH AVE
Practice Address - Street 2:SUITE 1602
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-5006
Practice Address - Country:US
Practice Address - Phone:917-701-8976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY82511103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist