Provider Demographics
NPI:1548024854
Name:JASPER-BRODY, MICHELLE CARYN (PSYD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:CARYN
Last Name:JASPER-BRODY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3515 HENRY HUDSON PKWY APT 8F
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1333
Mailing Address - Country:US
Mailing Address - Phone:917-250-8943
Mailing Address - Fax:
Practice Address - Street 1:10 N BROADWAY STE 1D
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-2211
Practice Address - Country:US
Practice Address - Phone:917-250-8943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016533-01103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty