Healthcare Provider Details

I. General information

NPI: 1629684691
Provider Name (Legal Business Name): JAYNE WRIGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2020
Last Update Date: 12/21/2025
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 OCEANSIDE RD
OCEANSIDE NY
11572-1521
US

IV. Provider business mailing address

10819 ROCKAWAY BLVD
SOUTH OZONE PARK NY
11420-1034
US

V. Phone/Fax

Practice location:
  • Phone: 516-205-4007
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: