MEDICARE: JESSICA PEARSON PSY.D.

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	103T00000X	Psychologist	016061	NY
2	103TC0700X	Clinical Psychologist	016061	NY
3	103TF0200X	Forensic Psychologist	016061	NY

General Provider Information

NPI Number	:	1376606079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA PEARSON PSY.D.

Provider Business Mailing Address
First Line	:	175 EASTERN PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11238-6056
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	19 W 34TH ST
Second Line	:	PH
City	:	NEW YORK
State	:	NY
Zip	:	10001-3006
Country	:	US
Telephone Number	:	212-947-7111
Fax Number	:

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

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	09/11/2025

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