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General NPI Number Information
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NPI Number | 1578721890
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Entity Type | Organization
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Legal Business Name | JAMIE L NAUHEIM PHD CLINICAL PSYCH PC
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Dates
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Enumeration Date | 05/23/2008
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Last Update Date | 07/02/2008
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Provider Practice Location Address
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Address Line | 223 ROANOKE AVE
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City | RIVERHEAD
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State | NY
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Zip | 11901-2778
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Country | US
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Telephone | 631-727-8270
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Fax | 631-369-9423
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Provider Business Mailing Address
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Address Line | 223 ROANOKE AVE
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City | RIVERHEAD
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State | NY
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Zip | 11901-2778
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Country | US
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Telephone | 631-727-8270
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Fax | 631-369-9423
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAMIE L NAUHEIM
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Credential | PHD
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Telephone | 631-727-8270
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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 | 0070621
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License Number State | NY
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