Healthcare Provider Details

I. General information

NPI: 1730574286
Provider Name (Legal Business Name): NEW PATH PSYCHOLOGY EDUCATIONAL AND PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2015
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6282 DUPONT STATION CT E STE 2
JACKSONVILLE FL
32217-2515
US

IV. Provider business mailing address

6320 SAINT AUGUSTINE RD STE 6A
JACKSONVILLE FL
32217-2813
US

V. Phone/Fax

Practice location:
  • Phone: 904-900-3594
  • Fax: 904-485-8760
Mailing address:
  • Phone: 904-900-3594
  • Fax: 904-485-8760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY7468
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. JESSICA ANDERTON
Title or Position: OWNER/PROVIDER
Credential: PSYD.
Phone: 904-900-3594