Provider Demographics
NPI:1427470194
Name:JORN, PAULA KONNOR (PSYD)
Entity type:Individual
Prefix:DR
First Name:PAULA
Middle Name:KONNOR
Last Name:JORN
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 1:310 E 44TH ST
Mailing Address - Street 2:#916
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-4422
Mailing Address - Country:US
Mailing Address - Phone:732-822-0425
Mailing Address - Fax:646-649-4042
Practice Address - Street 1:310 E 44TH ST
Practice Address - Street 2:#916
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-4422
Practice Address - Country:US
Practice Address - Phone:732-822-0425
Practice Address - Fax:646-649-4042
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-14
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017554-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist