Provider Demographics
NPI:1013740711
Name:DR. JENNIFER WERTOVITCH PSYD PSYCHOLOGIST PC
Entity type:Organization
Organization Name:DR. JENNIFER WERTOVITCH PSYD PSYCHOLOGIST PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:WERTOVITCH
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:631-542-2649
Mailing Address - Street 1:9 BRUNSWICK RD
Mailing Address - Street 2:
Mailing Address - City:LK RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-1607
Mailing Address - Country:US
Mailing Address - Phone:631-805-0323
Mailing Address - Fax:
Practice Address - Street 1:9 BRUNSWICK RD
Practice Address - Street 2:
Practice Address - City:LK RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-1607
Practice Address - Country:US
Practice Address - Phone:631-805-0323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-20
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty