| Jennifer Smith Psychologist Pc | |
|
12904 Newport Ave Rockaway Park NY 11694-1617 | |
| (347) 523-5321 | |
| Not Available |
| Full Name | Jennifer Smith Psychologist Pc |
|---|---|
| Speciality | Psychologist |
| Location | 12904 Newport Ave, Rockaway Park, New York |
| Authorized Official Name and Position | Jennifer L Smith (CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 9173552031 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jennifer Smith Psychologist Pc 44 Point Breeze Ave Breezy Point NY 11697-1621 Ph: (917) 355-2031 | Jennifer Smith Psychologist Pc 12904 Newport Ave Rockaway Park NY 11694-1617 Ph: (347) 523-5321 |
| NPI Number | 1235650201 |
|---|---|
| Provider Enumeration Date | 06/29/2017 |
| Last Update Date | 12/02/2022 |
| Certification Date | 12/02/2022 |
| Medicare PECOS PAC ID | 5496027278 |
|---|---|
| Medicare Enrollment ID | O20170815002076 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235650201 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 015747 (New York) | Primary |
| Provider Name | Jennifer Loretta Smith |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1982026100 PECOS PAC ID: 8022234830 Enrollment ID: I20170815002697 |
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