Healthcare Provider Details

I. General information

NPI: 1225786361
Provider Name (Legal Business Name): JESSYKA LIVATINO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JESSYKA ROSEBURG

II. Dates (important events)

Enumeration Date: 03/17/2022
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 MONTAUK HWY UNIT C
COPIAGUE NY
11726-4903
US

IV. Provider business mailing address

903 MONTAUK HWY UNIT C PMB 7009
COPIAGUE NY
11726-4903
US

V. Phone/Fax

Practice location:
  • Phone: 516-519-3372
  • Fax:
Mailing address:
  • Phone: 516-519-3372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: