Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 01778 | NY |
N | 103T00000X | Psychologist | 01778 | NY |
N | 103TA0700X | Adult Development & Aging Psychologist | 01778 | NY |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 01778 | NY |
N | 103G00000X | Clinical Psychologist | 01778 | NY |
N | 103TC0700X | Clinical Psychologist | 01778 | NY |
N | 103TH0100X | Health Service | 01778 | NY |
N | 103TP0814X | Psychoanalysis | 01778 | NY |
N | 103TP2701X | Group Psychotherapist | 01778 | NY |
NPI | 1063407054 |
---|---|
Provider Name | Ann D Gracer |
First Address | Fresh Meadows, NY 11365-3204 |
Second Address | Fresh Meadows, NY 11365-3204 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01413547 | (05) | NY |
179302 | MHN (01) | NY |
S11486 | (02) | NY |