Healthcare Provider Details

I. General information

NPI: 1588971675
Provider Name (Legal Business Name): JESSICA LEIGH ESCOTT PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2010
Last Update Date: 10/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E 75TH ST 1A
NEW YORK NY
10021-2838
US

IV. Provider business mailing address

111 E 75TH ST 1A
NEW YORK NY
10021-2838
US

V. Phone/Fax

Practice location:
  • Phone: 631-901-3525
  • Fax:
Mailing address:
  • Phone: 631-901-3525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number021904
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: