Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | V17321 | NY |
Y | 103TC0700X | Clinical Psychologist | V17321 | NY |
NPI | 1003959461 |
---|---|
Provider Name | Dr. Gisa Indenbaum |
First Address | New York, NY 10024-3608 |
Second Address | New York, NY 10024-3608 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2007 |
Last Update Date | 08/07/2007 |