Provider Information for 1265719587
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JESSICA A VASSALLO LCSW
Sex: Female
NPI: 1265719587
Last Updated: 2023-10-10
Certification Date: 2023-10-10
Certification Date: 2023-10-10
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1265719587 | ||||||||
| Enumeration Date | 2011-11-15 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1889 HELEN CT MERRICK, NY 11566-4929 United States Phone: 516-567-7101 | Fax: | ||||||||
| Primary Practice Address | 109 W 27TH ST STE 5S NEW YORK, NY 10001-6208 United States Phone: 833-351-8255 | Fax: | ||||||||
| Secondary Practice Address(es) | 1889 HELEN CT | ||||||||
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