Provider Demographics
NPI:1003643248
Name:KATZ, JASON S (PMH-BC, RN)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:S
Last Name:KATZ
Suffix:
Gender:M
Credentials:PMH-BC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:558 WHITNEY AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-2229
Mailing Address - Country:US
Mailing Address - Phone:215-805-4969
Mailing Address - Fax:
Practice Address - Street 1:558 WHITNEY AVE APT 8
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-2229
Practice Address - Country:US
Practice Address - Phone:215-805-4969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT179444163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health