Healthcare Provider Details

I. General information

NPI: 1326599762
Provider Name (Legal Business Name): JESSICA JANKOWSKI NYSENBAUM PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2016
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6931 ARLINGTON RD STE 309
BETHESDA MD
20814-5285
US

IV. Provider business mailing address

6312 CAMEO CT
ROCKVILLE MD
20852-3548
US

V. Phone/Fax

Practice location:
  • Phone: 773-443-9143
  • Fax:
Mailing address:
  • Phone: 773-443-9143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License NumberPSYA00099
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number06061
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: