Provider Demographics
NPI:1295109486
Name:PURDY, JADE (CASAC-T)
Entity type:Individual
Prefix:
First Name:JADE
Middle Name:
Last Name:PURDY
Suffix:
Gender:F
Credentials:CASAC-T
Other - Prefix:
Other - First Name:JADE
Other - Middle Name:
Other - Last Name:PURDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CASAC-T
Mailing Address - Street 1:214 W 116TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026-2494
Mailing Address - Country:US
Mailing Address - Phone:212-602-1400
Mailing Address - Fax:212-602-1892
Practice Address - Street 1:214 W 116TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10026-2494
Practice Address - Country:US
Practice Address - Phone:212-602-1400
Practice Address - Fax:212-602-1892
Is Sole Proprietor?:No
Enumeration Date:2015-11-25
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY29780101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)