Provider Demographics
NPI:1992986566
Name:GULLESSERIAN STRALEY, JENNIFER ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ANN
Last Name:GULLESSERIAN STRALEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:GULLESSERIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:180 S BROADWAY STE 202
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-1820
Mailing Address - Country:US
Mailing Address - Phone:914-414-2253
Mailing Address - Fax:914-214-8476
Practice Address - Street 1:180 S BROADWAY STE 202
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-1820
Practice Address - Country:US
Practice Address - Phone:914-414-2253
Practice Address - Fax:914-214-8476
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-23
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018273-1103T00000X
103TS0200X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool