MEDICARE: JENNIFER A HASTINGS PHD

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	016867-1	NY

General Provider Information

NPI Number	:	1629125034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER A HASTINGS PHD

Provider Business Mailing Address
First Line	:	222 SHEER ROAD
Second Line	:
City	:	AVERILL PARK
State	:	NY
Zip	:	12018
Country	:	US
Telephone Number	:	518-674-0897
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 7TH AVE
Second Line	:
City	:	TROY
State	:	NY
Zip	:	12180-3410
Country	:	US
Telephone Number	:	518-270-2800
Fax Number	:	518-270-2723

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

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	07/08/2007

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