Individual
DR. JENNICA LAINE-FORMISANO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
260 KINGS MALL CT # 331, KINGSTON, NY 12401-1574
(845) 489-3687
Mailing address
148 BURT ST, SAUGERTIES, NY 12477-1907
(845) 489-3687
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
021267-1
NY
Other
Enumeration date
01/04/2013
Last updated
05/07/2021
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