Provider Demographics
NPI:1306347612
Name:OSTAD, JESSICA (LMHC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:OSTAD
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 E SHORE RD PH 2
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-2449
Mailing Address - Country:US
Mailing Address - Phone:516-376-0528
Mailing Address - Fax:516-348-0288
Practice Address - Street 1:55 W AMES CT STE 100
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-2304
Practice Address - Country:US
Practice Address - Phone:516-376-0528
Practice Address - Fax:516-348-0288
Is Sole Proprietor?:No
Enumeration Date:2018-02-22
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008442101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health