Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | 017456 | NY |
Y | 103G00000X | Clinical Psychologist | 017456 | NY |
Y | 103TC0700X | Clinical Psychologist | 017456 | NY |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 017456 | NY |
NPI | 1083897383 |
---|---|
Provider Name | Courtney M Rennicke |
First Address | New York, NY 10022-2707 |
Second Address | New York, NY 10022-2707 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/12/2007 |
Last Update Date | 10/12/2007 |