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General NPI Number Information
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NPI Number | 1760784243
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Entity Type | Organization
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Legal Business Name | UPPER EAST SIDE PSYCHOLOGY SERVICES P.C.
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Dates
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Enumeration Date | 12/03/2010
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Last Update Date | 08/16/2011
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Provider Practice Location Address
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Address Line | 343 E 78TH ST SUITE D
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City | NEW YORK
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State | NY
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Zip | 10075-1315
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Country | US
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Telephone | 212-537-6813
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Fax | 212-655-4459
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Provider Business Mailing Address
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Address Line | 1461 A FIRST AVENUE SUITE # 315
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City | NEW YORK
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State | NY
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Zip | 10075
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Country | US
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Telephone | 212-537-6813
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Fax | 212-655-4459
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Authorized Official
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Title or Position | CEO
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Name | DR. JACQUELINE SIMON
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Credential | PSY.D.
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Telephone | 212-537-6813
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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 | 015689
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License Number State | NY
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