Provider Demographics
NPI:1831243948
Name:JRD PSYCHOLOGICAL SVCS PC
Entity type:Organization
Organization Name:JRD PSYCHOLOGICAL SVCS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:R
Authorized Official - Last Name:DONNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:607-732-5427
Mailing Address - Street 1:371 W CHURCH ST
Mailing Address - Street 2:SUITE #1
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-2620
Mailing Address - Country:US
Mailing Address - Phone:607-732-5427
Mailing Address - Fax:607-732-6853
Practice Address - Street 1:371 W CHURCH ST
Practice Address - Street 2:SUITE #1
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-2620
Practice Address - Country:US
Practice Address - Phone:607-732-5427
Practice Address - Fax:607-732-6853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
52597AMedicare ID - Type Unspecified