Provider Demographics
NPI:1881963692
Name:JESSELSON, MAURICIO
Entity type:Individual
Prefix:DR
First Name:MAURICIO
Middle Name:
Last Name:JESSELSON
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:MAURICIO
Other - Middle Name:Z
Other - Last Name:JESSELSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:232 MADISON AVE
Mailing Address - Street 2:10TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-2901
Mailing Address - Country:US
Mailing Address - Phone:917-846-3934
Mailing Address - Fax:
Practice Address - Street 1:232 MADISON AVE
Practice Address - Street 2:10TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-2901
Practice Address - Country:US
Practice Address - Phone:917-846-3934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018940103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist