Provider Demographics
NPI:1487487625
Name:NANCY DEJEAN LLC
Entity type:Organization
Organization Name:NANCY DEJEAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:RENAUD DEJEAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:516-524-5302
Mailing Address - Street 1:320 IVY AVE
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-1916
Mailing Address - Country:US
Mailing Address - Phone:516-524-5302
Mailing Address - Fax:
Practice Address - Street 1:320 IVY AVE
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-1916
Practice Address - Country:US
Practice Address - Phone:516-524-5302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty