Provider Demographics
NPI:1831302934
Name:JEWEJLL, ANDREA KAREN (PSYD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:KAREN
Last Name:JEWEJLL
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 1:920 BROADWAY
Mailing Address - Street 2:SUITE 8
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-6004
Mailing Address - Country:US
Mailing Address - Phone:212-615-6931
Mailing Address - Fax:
Practice Address - Street 1:920 BROADWAY
Practice Address - Street 2:SUITE 8
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-6004
Practice Address - Country:US
Practice Address - Phone:212-615-6931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013159103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical