Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 022159 | NY |
Y | 103T00000X | Psychologist | 022159 | NY |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 022159 | NY |
N | 103G00000X | Clinical Psychologist | 022159 | NY |
N | 103TC0700X | Clinical Psychologist | 022159 | NY |
N | 103TH0004X | Health Psychologist | 022159 | NY |
N | 103TP2701X | Group Psychotherapist | 022159 | NY |
NPI | 1417427774 |
---|---|
Provider Name | Dr. David Statman |
First Address | Cedarhurst, NY 11516-1126 |
Second Address | Jamaica, NY 11433-1104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2018 |
Last Update Date | 29/11/2018 |