Healthcare Provider Details

I. General information

NPI: 1033042791
Provider Name (Legal Business Name): J. LOGAN NP IN PSYCHIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 ROSEMONT ST
ALBANY NY
12203-2405
US

IV. Provider business mailing address

22 ROSEMONT ST
ALBANY NY
12203-2405
US

V. Phone/Fax

Practice location:
  • Phone: 802-236-2611
  • Fax: 802-236-2611
Mailing address:
  • Phone: 802-236-2611
  • Fax: 802-236-2611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER LOGAN
Title or Position: OWNER
Credential: PMHNP
Phone: 802-236-2611