Healthcare Provider Details

I. General information

NPI: 1033751060
Provider Name (Legal Business Name): PERSONS PSYCHOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2019
Last Update Date: 10/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 W 22ND ST STE 2B
NEW YORK NY
10010-5805
US

IV. Provider business mailing address

34 W 22ND ST STE 2B
NEW YORK NY
10010-5805
US

V. Phone/Fax

Practice location:
  • Phone: 813-389-1788
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. LOGAN PERSONS JONES
Title or Position: OWNER/HEAD OF PRACTICE
Credential: PSY.D,
Phone: 813-389-1788