Provider Demographics
NPI:1912321365
Name:LEWIN-ZMOOD, JESSICA TRACY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:TRACY
Last Name:LEWIN-ZMOOD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 WEST 72ND STREET
Mailing Address - Street 2:#403
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023
Mailing Address - Country:US
Mailing Address - Phone:917-847-4451
Mailing Address - Fax:
Practice Address - Street 1:133 WEST 72ND STREET
Practice Address - Street 2:#403
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023
Practice Address - Country:US
Practice Address - Phone:917-847-4451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-05
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020425-1103TB0200X, 103TC0700X, 103TP2701X
NY020425103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy