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General NPI Number Information
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NPI Number | 1902275530
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Entity Type | Individual
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Provider Name | JESSA NAVIDE PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 09/24/2015
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Last Update Date | 04/19/2023
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Provider Practice Location Address
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Address Line | 276 5TH AVE RM 605
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City | NEW YORK
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State | NY
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Zip | 10001-4527
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Country | US
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Telephone | 917-847-7556
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Fax |
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Provider Business Mailing Address
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Address Line | 113 FARMDALE CT
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City | LAKESIDE PARK
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State | KY
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Zip | 41017-3194
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Country | US
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Telephone | 859-486-1488
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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 | 025312
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License Number State | NY
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