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General NPI Number Information
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NPI Number | 1467172320
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Entity Type | Individual
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Provider Name | JEANNE M SEVELIUS PHD
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Gender | Female
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Dates
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Enumeration Date | 08/31/2022
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Last Update Date | 05/22/2023
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Provider Practice Location Address
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Address Line | 722 W 168TH ST
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City | NEW YORK
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State | NY
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Zip | 10032-3727
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Country | US
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Telephone | 646-774-6931
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Fax |
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Provider Business Mailing Address
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Address Line | 327 W 11TH ST APT 2E
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City | NEW YORK
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State | NY
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Zip | 10014-6221
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Country | US
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Telephone | 510-703-5990
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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 | PSY26349
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 025700
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License Number State | NY
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