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General NPI Number Information
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NPI Number | 1144705559
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Entity Type | Individual
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Provider Name | JORDAN BATE PHD
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Gender | Female
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Dates
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Enumeration Date | 10/02/2018
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Last Update Date | 10/02/2018
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Provider Practice Location Address
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Address Line | 1619 3RD AVE STE 1
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City | NEW YORK
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State | NY
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Zip | 10128-3459
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Country | US
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Telephone | 929-274-1242
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Fax |
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Provider Business Mailing Address
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Address Line | 2130 ADAM CLAYTON POWELL JR BLVD APT 6G
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City | NEW YORK
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State | NY
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Zip | 10027-3746
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Country | US
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Telephone | 978-502-4741
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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 | 022832-1
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License Number State | NY
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