Provider Demographics
NPI:1770614745
Name:DEIGNAN, JODIE (NPP, PMHNP-BC, MT-BC)
Entity type:Individual
Prefix:
First Name:JODIE
Middle Name:
Last Name:DEIGNAN
Suffix:
Gender:F
Credentials:NPP, PMHNP-BC, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 MCKINLEY AVE APT DG-8
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10606-1659
Mailing Address - Country:US
Mailing Address - Phone:508-317-2486
Mailing Address - Fax:
Practice Address - Street 1:180 S BROADWAY STE 301A
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-1820
Practice Address - Country:US
Practice Address - Phone:914-216-7550
Practice Address - Fax:412-900-1132
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6309491163WP0807X
225A00000X
CT12.010154363LP0808X
MARN2351852363LP0808X
NY401321363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist