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General NPI Number Information
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NPI Number | 1669538757
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Entity Type | Individual
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Provider Name | JODI N. LICHT PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 12/31/2006
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Last Update Date | 06/15/2009
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Provider Practice Location Address
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Address Line | 25517 NORTHERN BLVD SUITE 2B
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City | LITTLE NECK
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State | NY
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Zip | 11362-1453
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Country | US
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Telephone | 917-364-8585
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Fax |
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Provider Business Mailing Address
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Address Line | 24008 65TH AVE
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City | DOUGLASTON
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State | NY
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Zip | 11362-1921
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Country | US
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Telephone | 917-364-8585
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 016200
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License Number State | NY
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