Provider Demographics
NPI:1487084596
Name:DR. JESSICA B. KORDANSKY, PA
Entity type:Organization
Organization Name:DR. JESSICA B. KORDANSKY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:B
Authorized Official - Last Name:KORDANSKY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:404-452-7841
Mailing Address - Street 1:399 NW 2ND AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-3845
Mailing Address - Country:US
Mailing Address - Phone:561-318-1743
Mailing Address - Fax:561-953-9238
Practice Address - Street 1:399 NW 2ND AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-3845
Practice Address - Country:US
Practice Address - Phone:561-318-1743
Practice Address - Fax:561-953-9238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-26
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8369103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty