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General NPI Number Information
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NPI Number | 1811958705
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Entity Type | Individual
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Provider Name | JEANELL PERRY-MONTGOMERY PH.D.
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Gender | Female
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Dates
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Enumeration Date | 03/30/2006
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Last Update Date | 08/03/2008
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Provider Practice Location Address
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Address Line | 26 COURT ST SUITE 26 ROOM 3
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City | BROOKLYN
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State | NY
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Zip | 11242-0103
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Country | US
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Telephone | 347-675-3420
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Fax |
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Provider Business Mailing Address
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Address Line | 8 REDDINGTON DR
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City | MATAWAN
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State | NJ
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Zip | 07747-6647
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Country | US
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Telephone | 732-765-1993
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Fax | 732-765-0588
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 010328-1
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License Number State | NY
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