Healthcare Provider Details

I. General information

NPI: 1932873502
Provider Name (Legal Business Name): LIBERATION PSYCHOLOGICAL SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2021
Last Update Date: 06/02/2022
Certification Date: 06/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 HERITAGE LANDING DR STE F
EAST SYRACUSE NY
13057-9378
US

IV. Provider business mailing address

5800 HERITAGE LANDING DR STE F
EAST SYRACUSE NY
13057-9378
US

V. Phone/Fax

Practice location:
  • Phone: 315-928-2527
  • Fax: 315-303-6303
Mailing address:
  • Phone: 315-928-2527
  • Fax: 315-303-6303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. JASMIN NICOLE JONES
Title or Position: PSYCHOLOGIST
Credential: PHD
Phone: 315-928-2527