Individual
MS. JEANNE OTTAWAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
279 SUFFOLK AVE, STATEN ISLAND, NY 10314-6948
(718) 370-9068
Mailing address
547 PELTON AVE, STATEN ISLAND, NY 10310-2915
(718) 442-4391
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
012589-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9610248
GHI
NY
Enumeration date
12/13/2006
Last updated
07/08/2007
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