Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 011969 | NY |
Y | 103TC0700X | Clinical Psychologist | 011969 | NY |
NPI | 1003936048 |
---|---|
Provider Name | Dr. Maryann Diviney Juska |
First Address | New York, NY 10022-3607 |
Second Address | New York, NY 10022-3662 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2007 |
Last Update Date | 08/07/2007 |