MEDICARE: DR. JASON V. FLEMMING 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	101YM0800X	Mental Health Counselor	003268	NY

General Provider Information

NPI Number	:	1649344078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON V. FLEMMING PSY.D

Provider Business Mailing Address
First Line	:	12611 146TH ST
Second Line	:
City	:	SOUTH OZONE PARK
State	:	NY
Zip	:	11436-1911
Country	:	US
Telephone Number	:	718-288-4161
Fax Number	:	718-282-2727

Provider Business Practice Location Address
First Line	:	4012 CHURCH AVE, 2ND FL.
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-2917
Country	:	US
Telephone Number	:	718-282-0777
Fax Number	:	718-282-2727

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

Provider Enumeration Date	:	11/18/2006
Last Update Date	:	07/08/2007

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