Provider Demographics
NPI:1376777367
Name:TESAK, JENNIFER ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ANN
Last Name:TESAK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:MONESCALCHI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:122 BUSINESS PARK DR STE 1
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-6321
Mailing Address - Country:US
Mailing Address - Phone:315-732-3431
Mailing Address - Fax:866-822-2343
Practice Address - Street 1:122 BUSINESS PARK DR STE 1
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-6321
Practice Address - Country:US
Practice Address - Phone:315-732-3431
Practice Address - Fax:866-822-2343
Is Sole Proprietor?:No
Enumeration Date:2009-05-06
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018603-01103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical