Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 280013081 | NY |
NPI | 1235703174 |
---|---|
Provider Name | Audrey Gonsalves Sookdeo |
First Address | Brooklyn, NY 11225-5556 |
Second Address | Huntington Station, NY 11746-3905 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2021 |
Last Update Date | 15/05/2021 |