Healthcare Provider Details

I. General information

NPI: 1376037036
Provider Name (Legal Business Name): JENILEE ACCURSO MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2018
Last Update Date: 06/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 NORTHWOODS BLVD
COLUMBUS OH
43235-4720
US

IV. Provider business mailing address

5736 BONALY CT
DUBLIN OH
43016-9439
US

V. Phone/Fax

Practice location:
  • Phone: 614-841-9763
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: