Individual
DR. JENNIFER ANNE FAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
170 MONTAUK HIGHWAY, SPEONK, NY 11972
(631) 603-8424
Mailing address
P.O. BOX 595, SPEONK, NY 11972
(631) 603-8424
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
015538-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
204201086
TAX IDENTIFICATION NUMBER
NY
Enumeration date
09/20/2006
Last updated
04/28/2010
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