| Jennica Laine-formisano Psyd | |
|
260 Kings Mall Ct # 331 Kingston NY 12401-1574 | |
| (845) 489-3687 | |
| (845) 332-6041 |
| Full Name | Jennica Laine-formisano Psyd |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 260 Kings Mall Ct # 331, Kingston, New York |
| Authorized Official Name and Position | Jennica Laine-formisano (OWNER) |
| Authorized Official Contact | 8454893687 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jennica Laine-formisano Psyd 260 Kings Mall Ct # 331 Kingston NY 12401-1574 Ph: (845) 489-3687 | Jennica Laine-formisano Psyd 260 Kings Mall Ct # 331 Kingston NY 12401-1574 Ph: (845) 489-3687 |
| NPI Number | 1093454159 |
|---|---|
| Provider Enumeration Date | 05/27/2022 |
| Last Update Date | 05/27/2022 |
| Certification Date | 05/26/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093454159 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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