Provider Demographics
NPI:1063267706
Name:PURNELL, JENNIFER (PHD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:PURNELL
Suffix:
Gender:U
Credentials:PHD
Other - Prefix:
Other - First Name:JAE
Other - Middle Name:
Other - Last Name:PURNELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1808 BEVERLEY RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-8605
Mailing Address - Country:US
Mailing Address - Phone:201-566-0761
Mailing Address - Fax:
Practice Address - Street 1:1808 BEVERLEY RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-8605
Practice Address - Country:US
Practice Address - Phone:201-566-0761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026242-01103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical