Jimmy K Master, PsyD
Psychologist, Clinical in Stony Brook, NY. Individual provider (NPI-1).
NPI number1164079802
StatusActive
Last updated in NPPESAug 19, 2019
Details
- NPI
- 1164079802
- Entity type
- Individual (NPI-1)
- Name
- Jimmy K Master
- Credential
- PsyD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Aug 19, 2019
- Last updated
- Aug 19, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 103TC0700X | Psychologist, Clinical | p13072 | NY | Yes |
Practice location
100 Nicolls RdStony Brook, NY 11794-0001
Phone 631-632-9510 · Fax 631-632-5870
Mailing address
Po Box 1554Stony Brook, NY 11790-0988
Phone 631-444-2990
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