Provider Demographics
NPI:1144893298
Name:GERBER, JENNIFER D (PHD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:D
Last Name:GERBER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 W 96TH ST APT 3CD
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6427
Mailing Address - Country:US
Mailing Address - Phone:646-342-4375
Mailing Address - Fax:
Practice Address - Street 1:350 CENTRAL PARK W APT 5E
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6501
Practice Address - Country:US
Practice Address - Phone:646-342-4375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014473-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY014473-1OtherLICENSE