Individual
DR. JACK LIVINGSTONE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D IN PSYCHOLOGY
Contact information
Practice address
25127 71ST RD, BELLEROSE, NY 11426-2725
(718) 347-3147
Mailing address
25127 71ST RD, BELLEROSE, NY 11426-2725
(718) 347-3147
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
8611
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00941915
—
NY
Enumeration date
06/16/2007
Last updated
07/09/2007
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