Active NPI
Elisabeth Jean-Jacques, PSY.D.
- Clinical Psychologist
- Laurel, MD
National Provider Identifier
1669923512
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY003762
- Practice address
- 7903 Orion Cir Apt H240
Laurel, MD 20724-3101 - Phone
- (352) 219-4969
- NPI assigned
- Oct 16, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY003762 | GA | Primary |
Addresses
Primary practice location
7903 Orion Cir Apt H240
Laurel, MD 20724-3101
Mailing address
7903 Orion Cir Apt H240
Laurel, MD 20724-3101
Phone (352) 219-4969
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY003762 | GA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1476576000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1476576000000",
"number": "1669923512",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7903 ORION CIR APT H240",
"city": "LAUREL",
"state": "MD",
"postal_code": "207243101",
"telephone_number": "352-219-4969"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7903 ORION CIR APT H240",
"city": "LAUREL",
"state": "MD",
"postal_code": "207243101",
"telephone_number": "352-219-4969"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JEAN-JACQUES",
"first_name": "ELISABETH",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-10-16",
"last_updated": "2016-10-16",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "GA",
"license": "PSY003762",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Laurel, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.