Healthcare Provider Details

I. General information

NPI: 1669385886
Provider Name (Legal Business Name): JESSE DZUBAK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N HARTLEY ST APT 305
YORK PA
17404-2855
US

IV. Provider business mailing address

600 N HARTLEY ST APT 305
YORK PA
17404-2855
US

V. Phone/Fax

Practice location:
  • Phone: 717-542-1495
  • Fax:
Mailing address:
  • Phone: 717-542-1495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC08662
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: