Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | 022139-1 | NY |
Y | 103G00000X | Clinical Psychologist | 022139-1 | NY |
Y | 103TC0700X | Clinical Psychologist | 022139-1 | NY |
N | 103TF0200X | Forensic Psychologist | 022139-1 | NY |
NPI | 1073892568 |
---|---|
Provider Name | Dr. Eugenia Dubus |
First Address | New York, NY 10019-3228 |
Second Address | New York, NY 10019-3228 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2011 |
Last Update Date | 21/10/2018 |