Healthcare Provider Details

I. General information

NPI: 1659596625
Provider Name (Legal Business Name): JEAN EDITH OKIE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 JORALEMON ST SUITE 9A
BROOKLYN NY
11201-4709
US

IV. Provider business mailing address

51 PROSPECT PL
BROOKLYN NY
11217-2801
US

V. Phone/Fax

Practice location:
  • Phone: 718-855-3365
  • Fax:
Mailing address:
  • Phone: 718-398-1657
  • Fax: 718-398-1659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number011256
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: