MEDICARE: JENNIFER BUCHHOLZ 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	025930	NY
2	103TC0700X	Clinical Psychologist	34408	CA

General Provider Information

NPI Number	:	1407538192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER BUCHHOLZ PHD

Provider Business Mailing Address
First Line	:	367 SAINT MARKS AVE # 1127
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11238-2268
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	367 SAINT MARKS AVE # 1127
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11238-2268
Country	:	US
Telephone Number	:	650-248-2653
Fax Number	:

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

Provider Enumeration Date	:	08/02/2023
Last Update Date	:	08/14/2025

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