Provider Demographics
NPI:1104265602
Name:REALE, JAMIE LORRAINE (MS SPECIAL EDUCATION)
Entity type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:LORRAINE
Last Name:REALE
Suffix:
Gender:F
Credentials:MS SPECIAL EDUCATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 SALAMANDER CT
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-1930
Mailing Address - Country:US
Mailing Address - Phone:347-630-7067
Mailing Address - Fax:
Practice Address - Street 1:116 W 32ND ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3212
Practice Address - Country:US
Practice Address - Phone:212-564-2350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1768311103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst