Provider Demographics
NPI:1598788895
Name:DEEB, JODI SALTZBERG (PHD)
Entity type:Individual
Prefix:DR
First Name:JODI
Middle Name:SALTZBERG
Last Name:DEEB
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4985 HARLEM ROAD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226
Mailing Address - Country:US
Mailing Address - Phone:716-839-0500
Mailing Address - Fax:416-839-0523
Practice Address - Street 1:4985 HARLEM ROAD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226
Practice Address - Country:US
Practice Address - Phone:416-839-0500
Practice Address - Fax:416-839-0523
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016135-1103T00000X
NY016135103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY364932OtherMHN
NY000528069001OtherBLUE CROSS/BLUE SHIELD
NY237718OtherVALUEOPTIONS
NY00026991101OtherUNIVERA
NY5465292OtherAETNA
NY6112811OtherINDEPENDENT HEALTH
NY00026991101OtherUNIVERA
NY000528069001OtherBLUE CROSS/BLUE SHIELD