Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 015236 | NY |
NPI | 1104178938 |
---|---|
Provider Name | Dr. Laurie Nathan |
First Address | New York, NY 10019-4264 |
Second Address | New York, NY 10019-4264 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2012 |
Last Update Date | 03/10/2012 |