Individual provider Active NPI

Leona M. Jaglom, PH.D.

  • Clinical Child & Adolescent Psychologist
  • Brooklyn, NY
National Provider Identifier
1538368477
Registry record updated Jul 11, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X
License
009805-1 Issued in NY
Practice address
102 Garfield PL
Brooklyn, NY 11215-2003
Phone
(718) 499-7245
Fax
(718) 499-7245
NPI assigned
Jul 11, 2007
Last updated
Jul 11, 2007By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 11, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Child & Adolescent Psychologist 103TC2200X 009805-1 NY Primary

Addresses

Primary practice location

102 Garfield PL
Brooklyn, NY 11215-2003

Mailing address

102 Garfield PL
Brooklyn, NY 11215-2003
Phone (718) 499-7245

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
009805-1NYMDMedical Physician Assistant

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1184112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184112000000",
    "number": "1538368477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 GARFIELD PL",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112152003",
            "telephone_number": "718-499-7245",
            "fax_number": "718-499-7245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 GARFIELD PL",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112152003",
            "telephone_number": "718-499-7245",
            "fax_number": "718-499-7245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAGLOM",
        "first_name": "LEONA",
        "middle_name": "M.",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-07-11",
        "last_updated": "2007-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "NY",
            "license": "009805-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.