Provider Demographics
NPI:1881736262
Name:JUSINO, CONCEPCION JR (PSYD)
Entity type:Individual
Prefix:MR
First Name:CONCEPCION
Middle Name:
Last Name:JUSINO
Suffix:JR
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 CHRISTOPHER COLUMBUS DR APT 1B
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-3500
Mailing Address - Country:US
Mailing Address - Phone:201-892-3594
Mailing Address - Fax:
Practice Address - Street 1:407 E 81ST ST APT 1A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-5831
Practice Address - Country:US
Practice Address - Phone:201-892-3594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012665-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist