Provider Demographics
NPI:1124617402
Name:JEAN-LOUIS, DANA MARIE (PSYD)
Entity type:Individual
Prefix:DR
First Name:DANA
Middle Name:MARIE
Last Name:JEAN-LOUIS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 W 72ND ST RM 5R
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-3278
Mailing Address - Country:US
Mailing Address - Phone:718-702-7069
Mailing Address - Fax:
Practice Address - Street 1:125 W 72ND ST RM 5R
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-3278
Practice Address - Country:US
Practice Address - Phone:718-702-7069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-12
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY025514103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program