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General NPI Number Information
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NPI Number | 1376362590
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Entity Type | Organization
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Legal Business Name | MAMARONECK NP IN PSYCHIATRY PLLC
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Dates
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Enumeration Date | 10/04/2024
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Last Update Date | 10/04/2024
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Provider Practice Location Address
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Address Line | 709 PALMER CT APT 2E
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City | MAMARONECK
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State | NY
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Zip | 10543-2442
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Country | US
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Telephone | 917-513-0273
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Fax |
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Provider Business Mailing Address
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Address Line | 709 PALMER CT APT 2E
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City | MAMARONECK
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State | NY
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Zip | 10543-2442
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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 | OWNER
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Name | DR. KRYSTYNA DE JACQ
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Credential | PHD, PMHNP-BC
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Telephone | 917-513-0273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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