MEDICARE: DR. JENNIFER ANDERSEN PSYD

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	021334-1	NY

General Provider Information

NPI Number	:	1952738544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER ANDERSEN PSYD

Provider Business Mailing Address
First Line	:	1081 SHORE PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11228-3919
Country	:	US
Telephone Number	:	347-651-1228
Fax Number	:

Provider Business Practice Location Address
First Line	:	117 DOBBIN ST STE 305D
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11222-2803
Country	:	US
Telephone Number	:	347-651-1228
Fax Number	:

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

Provider Enumeration Date	:	09/27/2013
Last Update Date	:	07/11/2019

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