Organization
MAMARONECK NP IN PSYCHIATRY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KRYSTYNA DE JACQ PHD, PMHNP-BC (OWNER)
(917) 513-0273
Entity
Organization
Contact information
Practice address
709 PALMER CT APT 2E, MAMARONECK, NY 10543-2442
(917) 513-0273
Mailing address
709 PALMER CT APT 2E, MAMARONECK, NY 10543-2442
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
10/04/2024
Last updated
10/04/2024
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