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General NPI Number Information
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NPI Number | 1235773086
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Entity Type | Organization
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Legal Business Name | JESSICA KOBLENZ, PSYD, PLLC
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Dates
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Enumeration Date | 11/05/2019
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Last Update Date | 11/05/2019
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Provider Practice Location Address
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Address Line | 3801 23RD AVE STE 306
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City | ASTORIA
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State | NY
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Zip | 11105-1978
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Country | US
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Telephone | 516-725-5551
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Fax |
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Provider Business Mailing Address
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Address Line | 3801 23RD AVE STE 306
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City | ASTORIA
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State | NY
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Zip | 11105-1978
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST III
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Name | JESSICA KOBLENZ
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Credential | PSYD
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Telephone | 516-725-5551
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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