Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 022038 | NY |
NPI | 1093255978 |
---|---|
Provider Name | Dr. Steve Jenkins |
First Address | Woodside, NY 11377-3149 |
Second Address | Staten Island, NY 10305-2246 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2017 |
Last Update Date | 27/02/2017 |