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General NPI Number Information
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NPI Number | 1588840201
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Entity Type | Organization
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Legal Business Name | JEPHTHA TAUSIG-EDWARDS, PHD PLLC
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Dates
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Enumeration Date | 01/11/2008
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Last Update Date | 01/11/2008
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Provider Practice Location Address
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Address Line | 295 CENTRAL PARK W SUITE 2
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City | NEW YORK
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State | NY
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Zip | 10024-3008
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Country | US
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Telephone | 212-595-9348
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Fax |
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Provider Business Mailing Address
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Address Line | 295 CENTRAL PARK W SUITE 2
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City | NEW YORK
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State | NY
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Zip | 10024-3008
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Country | US
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Telephone | 212-595-9348
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. JEPHTHA TAUSIG-EDWARDS
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Credential | PHD
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Telephone | 212-595-9348
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 016753-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 016753-1
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License Number State | NY
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