MEDICARE: DR. JODI B. STREICH PH.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	103TC0700X	Clinical Psychologist	4852	NJ

General Provider Information

NPI Number	:	1659665743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JODI B. STREICH PH.D.

Provider Business Mailing Address
First Line	:	80 RIVER ST
Second Line	:	SUITE 302
City	:	HOBOKEN
State	:	NJ
Zip	:	07030-5626
Country	:	US
Telephone Number	:	201-736-2502
Fax Number	:

Provider Business Practice Location Address
First Line	:	80 RIVER ST
Second Line	:	SUITE 302
City	:	HOBOKEN
State	:	NJ
Zip	:	07030-5626
Country	:	US
Telephone Number	:	201-736-2502
Fax Number	:

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

Provider Enumeration Date	:	06/06/2011
Last Update Date	:	01/27/2012

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