Provider Demographics
NPI:1396142212
Name:JESSIE KIVLEHAN
Entity type:Organization
Organization Name:JESSIE KIVLEHAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSIE
Authorized Official - Middle Name:HASTINGS
Authorized Official - Last Name:KIVLEHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:845-558-6019
Mailing Address - Street 1:4 PRINCETON DR
Mailing Address - Street 2:
Mailing Address - City:TAPPAN
Mailing Address - State:NY
Mailing Address - Zip Code:10983
Mailing Address - Country:US
Mailing Address - Phone:845-558-6019
Mailing Address - Fax:
Practice Address - Street 1:4 PRINCETON DR
Practice Address - Street 2:
Practice Address - City:TAPPAN
Practice Address - State:NY
Practice Address - Zip Code:10983
Practice Address - Country:US
Practice Address - Phone:845-558-6019
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-20
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health