Healthcare Provider Details

I. General information

NPI: 1316766355
Provider Name (Legal Business Name): JORDAN DUNN PHD
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

574 ATLANTIC AVE APT 2
BROOKLYN NY
11217-4911
US

IV. Provider business mailing address

574 ATLANTIC AVE APT 2
BROOKLYN NY
11217-4911
US

V. Phone/Fax

Practice location:
  • Phone: 646-494-8906
  • Fax:
Mailing address:
  • Phone: 646-494-8906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number026753
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: