Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | 0173961 | NY |
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 0173961 | NY |
NPI | 1134384027 |
---|---|
Provider Name | Dr. Alexandra Degeorge |
First Address | New York, NY 10016-6404 |
Second Address | New York, NY 10016-6404 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2008 |
Last Update Date | 21/07/2008 |