MEDICARE: ANNIE LEE JONES PH.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	103TC0700X	Clinical Psychologist	005988	NY

General Provider Information

NPI Number	:	1508806688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNIE LEE JONES PH.D.

Provider Business Mailing Address
First Line	:	8675 MIDLAND PKWY
Second Line	:	APT. 5J
City	:	JAMAICA
State	:	NY
Zip	:	11432-3049
Country	:	US
Telephone Number	:	718-297-4883
Fax Number	:

Provider Business Practice Location Address
First Line	:	8786 188TH ST
Second Line	:	HOLLIS
City	:	JAMAICA
State	:	NY
Zip	:	11423-1131
Country	:	US
Telephone Number	:	718-658-4648
Fax Number	:

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

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	09/12/2014

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