Healthcare Provider Details

I. General information

NPI: 1891034617
Provider Name (Legal Business Name): STEPHANIE FAGIN-JONES PHD CLINICAL PSYCHOLOGIST PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2013
Last Update Date: 02/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 W 70TH ST 201
NEW YORK NY
10023-4304
US

IV. Provider business mailing address

210 W 70TH ST 201
NEW YORK NY
10023-4304
US

V. Phone/Fax

Practice location:
  • Phone: 917-225-2497
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number016180
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number016180
License Number StateNY

VIII. Authorized Official

Name: DR. STEPHANIE JONES
Title or Position: OWNER
Credential: PH.D.
Phone: 917-225-2497