Provider Demographics
NPI:1174892277
Name:MAY, JENNIFER ANNE (PHD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ANNE
Last Name:MAY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:ANNE
Other - Last Name:JABLONSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:3208 WILSHIRE LN
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11769-1445
Mailing Address - Country:US
Mailing Address - Phone:631-750-7340
Mailing Address - Fax:
Practice Address - Street 1:140 BELLE MEAD RD
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-6400
Practice Address - Country:US
Practice Address - Phone:631-328-5930
Practice Address - Fax:631-675-1338
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016143103TB0200X, 103TC0700X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy