Provider Demographics
NPI:1932465556
Name:JESSICA R CESARE, PSYCHOLOGIST, PH.D., P.C.
Entity Type:Organization
Organization Name:JESSICA R CESARE, PSYCHOLOGIST, PH.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:CESARE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:516-244-8368
Mailing Address - Street 1:450 SHORE RD
Mailing Address - Street 2:2G
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-5326
Mailing Address - Country:US
Mailing Address - Phone:516-244-8368
Mailing Address - Fax:516-572-1426
Practice Address - Street 1:165 N VILLAGE AVE
Practice Address - Street 2:9
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-3761
Practice Address - Country:US
Practice Address - Phone:516-244-8368
Practice Address - Fax:516-572-1426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018952103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA300058580Medicare UPIN