Provider Demographics
NPI:1962641464
Name:JENNIFER POWERS PHD LICENSED PSYCHOLOGIST PLLC
Entity Type:Organization
Organization Name:JENNIFER POWERS PHD LICENSED PSYCHOLOGIST PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:R
Authorized Official - Last Name:POWERS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:518-521-0115
Mailing Address - Street 1:18 LADY SLIPPER DR
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-9028
Mailing Address - Country:US
Mailing Address - Phone:518-521-0115
Mailing Address - Fax:
Practice Address - Street 1:428 GLEN ST
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-2929
Practice Address - Country:US
Practice Address - Phone:518-521-0115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-07
Last Update Date:2009-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017168251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health