Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 010827 | NY |
Y | 103T00000X | Psychologist | 010827 | NY |
N | 103G00000X | Clinical Psychologist | 010827 | NY |
N | 103TC0700X | Clinical Psychologist | 010827 | NY |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 010827 | NY |
N | 103TF0000X | Family Psychologist | 010827 | NY |
N | 103TP0814X | Psychoanalysis | 010827 | NY |
NPI | 1013225853 |
---|---|
Provider Name | Alan Supraner |
First Address | Bronx, NY 10463-4801 |
Second Address | Bronx, NY 10463-4801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2010 |
Last Update Date | 14/09/2010 |