Healthcare Provider Details

I. General information

NPI: 1720006265
Provider Name (Legal Business Name): JENNIFER HOTALING PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 CLIFTON COUNTRY RD STE 104
CLIFTON PARK NY
12065-3995
US

IV. Provider business mailing address

23 HELDERVUE AVE
SLINGERLANDS NY
12159-3600
US

V. Phone/Fax

Practice location:
  • Phone: 518-808-2426
  • Fax: 518-900-7614
Mailing address:
  • Phone: 518-808-2426
  • Fax: 518-900-7614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number014917
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: