Individual
JIMMY K MASTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
100 NICOLLS RD, STONY BROOK, NY 11794-0001
(631) 632-9510
(631) 632-5870
Mailing address
PO BOX 1554, STONY BROOK, NY 11790-0988
(631) 444-2990
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
P13072
NY
Other
Enumeration date
08/19/2019
Last updated
08/19/2019
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