Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 019258 | NY |
Y | 103TC0700X | Clinical Psychologist | 019258 | NY |
NPI | 1003322082 |
---|---|
Provider Name | Dr. Christine Marie Bartholoma |
First Address | Bayside, NY 11360-1204 |
Second Address | Bayside, NY 11360-1204 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2017 |
Last Update Date | 28/12/2017 |