MEDICARE: JAY CLIFFORD 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	103T00000X	Psychologist	PS005752L	PA

General Provider Information

NPI Number	:	1902471659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAY CLIFFORD PH.D.

Provider Business Mailing Address
First Line	:	6 LONGFORD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19136-2028
Country	:	US
Telephone Number	:	215-990-9541
Fax Number	:

Provider Business Practice Location Address
First Line	:	6 LONGFORD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19136-2028
Country	:	US
Telephone Number	:	215-990-9541
Fax Number	:

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

Provider Enumeration Date	:	05/25/2021
Last Update Date	:	05/25/2021

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Directions to “ JAY CLIFFORD PH.D.” Practice Location

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