Provider Demographics
NPI:1346062783
Name:DR. JESSICA CANNONE PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:DR. JESSICA CANNONE PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:CANNONE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:631-275-8641
Mailing Address - Street 1:4 FOXGLOVE CT
Mailing Address - Street 2:
Mailing Address - City:HOLTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11742-2518
Mailing Address - Country:US
Mailing Address - Phone:631-275-8641
Mailing Address - Fax:
Practice Address - Street 1:4 FOXGLOVE CT
Practice Address - Street 2:
Practice Address - City:HOLTSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11742-2518
Practice Address - Country:US
Practice Address - Phone:631-275-8641
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty