1730574286 NPI number — NEW PATH PSYCHOLOGY EDUCATIONAL AND PSYCHOLOGICAL SERVICES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730574286 NPI number — NEW PATH PSYCHOLOGY EDUCATIONAL AND PSYCHOLOGICAL SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW PATH PSYCHOLOGY EDUCATIONAL AND PSYCHOLOGICAL SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730574286
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/18/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6320 SAINT AUGUSTINE RD STE 6A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32217-2813
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-900-3594
Provider Business Mailing Address Fax Number:
904-485-8760

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6282 DUPONT STATION CT E STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32217-2515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-900-3594
Provider Business Practice Location Address Fax Number:
904-485-8760
Provider Enumeration Date:
04/01/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ANDERTON
Authorized Official First Name:
JESSICA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PROVIDER
Authorized Official Telephone Number:
904-900-3594

Provider Taxonomy Codes

  • Taxonomy code: 103TC2200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X , with the licence number: PY7468 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)