Provider Demographics
NPI:1982870499
Name:DAHAN, JACQUELINE FINE (PSYD)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:FINE
Last Name:DAHAN
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 1:21 W 86TH ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-3616
Mailing Address - Country:US
Mailing Address - Phone:917-903-1043
Mailing Address - Fax:
Practice Address - Street 1:21 W 86TH ST
Practice Address - Street 2:SUITE 209
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3616
Practice Address - Country:US
Practice Address - Phone:917-903-1043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017510103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist