Healthcare Provider Details

I. General information

NPI: 1407926611
Provider Name (Legal Business Name): JENNIFER L HARTSTEIN PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 06/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 W 25TH ST SIXTH FLOOR, SUITE 5
NEW YORK NY
10001-7405
US

IV. Provider business mailing address

138 W 25TH ST SIXTH FLOOR, SUITE 5
NEW YORK NY
10001-7405
US

V. Phone/Fax

Practice location:
  • Phone: 212-561-9727
  • Fax: 212-591-6483
Mailing address:
  • Phone: 212-561-9727
  • Fax: 212-591-6483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number016421
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: