Provider Demographics
NPI:1730574286
Name:NEW PATH PSYCHOLOGY EDUCATIONAL AND PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:NEW PATH PSYCHOLOGY EDUCATIONAL AND PSYCHOLOGICAL SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERTON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:904-900-3594
Mailing Address - Street 1:6320 SAINT AUGUSTINE RD STE 6A
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-2813
Mailing Address - Country:US
Mailing Address - Phone:904-900-3594
Mailing Address - Fax:904-485-8760
Practice Address - Street 1:6282 DUPONT STATION CT E STE 2
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2515
Practice Address - Country:US
Practice Address - Phone:904-900-3594
Practice Address - Fax:904-485-8760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-01
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TC2200X
FLPY7468103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty