MEDICARE: DR. JESSICA JOY PUTTRE PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist

General Provider Information

NPI Number	:	1588937221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSICA JOY PUTTRE PSY.D.

Provider Business Mailing Address
First Line	:	3771 NESCONSET HWY
Second Line	:	SUITE 214
City	:	SOUTH SETAUKET
State	:	NY
Zip	:	11720-1163
Country	:	US
Telephone Number	:	631-751-1420
Fax Number	:

Provider Business Practice Location Address
First Line	:	555 BROADHOLLOW RD 327
Second Line	:
City	:	MELVILLE
State	:	NY
Zip	:	11747-5018
Country	:	US
Telephone Number	:	631-629-5489
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2012
Last Update Date	:	09/28/2015

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