| Organization Name: | JERRY DUVINSKY PHD LICENSED PSYCHOLOGIST PC |
| NPI Number: | 1043684681 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JERRY DUVINSKY (PRESIDENT) |
| Mailing Address: | 423 E Main St Ste 3 Endicott |
| State: | NY US |
| Postal Code: | 137606940 |
| Phone Number: | 6077541101 |
| Fax Number: | 6077541107 |
| NPI Enumeration Date: | 11/19/2015 |
| NPI Last Update Date: | 11/19/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 010363 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |