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General NPI Number Information
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NPI Number | 1730574286
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Entity Type | Organization
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Legal Business Name | NEW PATH PSYCHOLOGY EDUCATIONAL AND PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 04/01/2015
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Last Update Date | 04/18/2024
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Provider Practice Location Address
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Address Line | 6282 DUPONT STATION CT E STE 2
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City | JACKSONVILLE
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State | FL
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Zip | 32217-2515
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Country | US
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Telephone | 904-900-3594
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Fax | 904-485-8760
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Provider Business Mailing Address
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Address Line | 6320 SAINT AUGUSTINE RD STE 6A
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City | JACKSONVILLE
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State | FL
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Zip | 32217-2813
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Country | US
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Telephone | 904-900-3594
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Fax | 904-485-8760
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | DR. JESSICA ANDERTON
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Credential | PSYD.
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Telephone | 904-900-3594
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY7468
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License Number State | FL
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