Provider Demographics
NPI:1588937221
Name:PUTTRE, JESSICA JOY (PSYD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:JOY
Last Name:PUTTRE
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 1:3771 NESCONSET HWY
Mailing Address - Street 2:SUITE 214
Mailing Address - City:SOUTH SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11720-1163
Mailing Address - Country:US
Mailing Address - Phone:631-751-1420
Mailing Address - Fax:
Practice Address - Street 1:555 BROADHOLLOW RD 327
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-5018
Practice Address - Country:US
Practice Address - Phone:631-629-5489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-10
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist