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General NPI Number Information
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NPI Number | 1184744633
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Entity Type | Individual
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Provider Name | JENNIFER LYNN CANTOR PH.D.
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Gender | Female
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 220 E 26TH ST SUITE LD
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City | NEW YORK
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State | NY
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Zip | 10010-2417
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Country | US
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Telephone | 347-268-3546
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Fax |
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Provider Business Mailing Address
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Address Line | 25 W 64TH ST APT. 9F
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City | NEW YORK
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State | NY
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Zip | 10023-6717
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Country | US
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Telephone | 212-579-2183
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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 | 015154-1
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License Number State | NY
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