Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 011945 | NY |
NPI | 1083035455 |
---|---|
Provider Name | Dr. Athena Anne Drewes |
First Address | Middletown, NY 10941-4050 |
Second Address | Middletown, NY 10941-4050 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2014 |
Last Update Date | 02/01/2014 |