MEDICARE: JESSICA ANN GERSON PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	014043	NY

General Provider Information

NPI Number	:	1346308996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA ANN GERSON PHD

Provider Business Mailing Address
First Line	:	421 AVENUE C
Second Line	:	APT 3A
City	:	BROOKLYN
State	:	NY
Zip	:	11218
Country	:	US
Telephone Number	:	718-222-1824
Fax Number	:	212-562-5518

Provider Business Practice Location Address
First Line	:	305 E 33RD ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10016-9401
Country	:	US
Telephone Number	:	855-698-4232
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	08/11/2022

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