Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist | 019577-1 | NY |
NPI | 1427680370 |
---|---|
Provider Name | Bonnie Marks |
First Address | New York, NY 10022-5111 |
Second Address | New York, NY 10022-5111 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2020 |
Last Update Date | 09/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
019577-1 | NY STATE LICENSE (01) | NY |