Healthcare Provider Details

I. General information

NPI: 1548189749
Provider Name (Legal Business Name): JESSICA JEANINE DESIMPLICIIS I
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3305 JERUSALEM AVE STE 207
WANTAGH NY
11793-2219
US

IV. Provider business mailing address

3305 JERUSALEM AVE STE 207
WANTAGH NY
11793-2219
US

V. Phone/Fax

Practice location:
  • Phone: 516-785-0323
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number018133
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: