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General NPI Number Information
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NPI Number | 1003100512
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Entity Type | Individual
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Provider Name | LAUREL JARVIS PH.D.
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Gender | Female
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Dates
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Enumeration Date | 06/01/2011
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 11050 MOUNT BELVEDERE BLVD BEHAVIORAL HEALTH DEPARTMENT, MEDDAC
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City | FORT DRUM
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State | NY
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Zip | 13602-5438
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Country | US
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Telephone | 315-772-4850
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Fax |
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Provider Business Mailing Address
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Address Line | 15980 COUNTY ROUTE 181
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City | CLAYTON
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State | NY
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Zip | 13624-3108
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Country | US
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Telephone | 202-270-8988
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 025329
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810002101
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License Number State | VA
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