=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265742183
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANA SCRIVANI PSY.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/13/2010
-----------------------------------------------------
Last Update Date | 04/10/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18 E 41ST ST RM 2002
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10017-6215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-535-5671
-----------------------------------------------------
Fax | 888-535-5671
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18 E 41ST ST RM 2002
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10017-6215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-535-5671
-----------------------------------------------------
Fax | 888-535-5671
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 018881
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PY 9165
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------