Provider Demographics
NPI:1811611742
Name:JESSICA SUZUKI PHD PSYCHOLOGICAL SERVICES PLLC
Entity type:Organization
Organization Name:JESSICA SUZUKI PHD PSYCHOLOGICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SENIOR PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUZUKI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:901-646-1024
Mailing Address - Street 1:503 50TH AVE APT 3C
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-5710
Mailing Address - Country:US
Mailing Address - Phone:212-961-7176
Mailing Address - Fax:
Practice Address - Street 1:125 E 23RD ST # 4033
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-4511
Practice Address - Country:US
Practice Address - Phone:901-646-1024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty