=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679436026
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JS NP IN PSYCHIATRY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/03/2025
-----------------------------------------------------
Last Update Date | 12/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5457 TWIN KNOLLS RD STE 300
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21045
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-661-7322
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1122 E 72ND ST
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11234-5408
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-661-7322
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JESSIE SEIDE
-----------------------------------------------------
Credential | PMHNP
-----------------------------------------------------
Telephone | 347-661-7322
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------