Basic Information
| Provider Information | |||||||||
| NPI: | 1437193950 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JESSAR | ||||||||
| FirstName: | JAMIE | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PSY.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 536 MORENO RD | ||||||||
| Address2: | |||||||||
| City: | WYNNEWOOD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190961121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6107470653 | ||||||||
| FaxNumber: | 2152572599 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 E LANCASTER AVE STE 306B | ||||||||
| Address2: | |||||||||
| City: | WYNNEWOOD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190962106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6107470653 | ||||||||
| FaxNumber: | 2152542599 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2006 | ||||||||
| LastUpdateDate: | 02/24/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PS006134L | PA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.