Provider Demographics
NPI:1932950631
Name:ARROYO, JESSICA LEE (LCAT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEE
Last Name:ARROYO
Suffix:
Gender:F
Credentials:LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19668 69TH AVE # 2
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-4033
Mailing Address - Country:US
Mailing Address - Phone:718-213-6490
Mailing Address - Fax:
Practice Address - Street 1:950 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-2927
Practice Address - Country:US
Practice Address - Phone:718-213-6490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-29
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002653225600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance Therapist