Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 020317-1 | NY |
Y | 103TC0700X | Clinical Psychologist | 020317-1 | NY |
NPI | 1003245671 |
---|---|
Provider Name | Dr. Melissa Corpus |
First Address | New York, NY 10016-6641 |
Second Address | New York, NY 10016-6641 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2013 |
Last Update Date | 01/10/2018 |