Healthcare Provider Details

I. General information

NPI: 1386581643
Provider Name (Legal Business Name): JIAYI WANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 MOUNTAIN BLVD STE 3
WARREN NJ
07059-5605
US

IV. Provider business mailing address

3623 CULLEN BLVD OFC 3314
HOUSTON TX
77204-5023
US

V. Phone/Fax

Practice location:
  • Phone: 732-795-2294
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number73145
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY-2023-0068
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: