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General NPI Number Information
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NPI Number | 1346556867
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Entity Type | Organization
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Legal Business Name | ILENE JURMANN, PH.D., PSYCHOLOGIST, P.C.
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Dates
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Enumeration Date | 08/21/2010
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Last Update Date | 08/21/2010
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Provider Practice Location Address
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Address Line | 5 DOWSING PL
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City | AMITYVILLE
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State | NY
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Zip | 11701-3719
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Country | US
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Telephone | 631-598-0147
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Fax |
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Provider Business Mailing Address
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Address Line | 51 ANN DR
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City | SYOSSET
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State | NY
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Zip | 11791-5906
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Country | US
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Telephone | 516-641-4961
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ILENE JURMANN
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Credential | PH.D.
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Telephone | 516-641-4961
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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 | 013920
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License Number State | NY
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