Provider Demographics
NPI:1912308461
Name:MCKELVEY, JENNIFER S (PHD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:S
Last Name:MCKELVEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3733 61ST ST
Mailing Address - Street 2:APT. 3C
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-2543
Mailing Address - Country:US
Mailing Address - Phone:917-586-6506
Mailing Address - Fax:
Practice Address - Street 1:3733 61ST ST
Practice Address - Street 2:APT. 3C
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-2543
Practice Address - Country:US
Practice Address - Phone:917-586-6506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-15
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020639103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical