Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 005083 | NY |
Y | 103T00000X | Psychologist | 005083 | NY |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 005083 | NY |
NPI | 1114043528 |
---|---|
Provider Name | Dr. Lola D. Nouryan |
First Address | Garden City, NY 11530-1564 |
Second Address | Garden City, NY 11530-5814 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2007 |
Last Update Date | 07/12/2018 |