Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 012527-1 | NY |
N | 103T00000X | Psychologist | 012527-1 | NY |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 012527-1 | NY |
N | 103TA0700X | Adult Development & Aging Psychologist | 012527-1 | NY |
Y | 103G00000X | Clinical Psychologist | 012527-1 | NY |
Y | 103TC0700X | Clinical Psychologist | 012527-1 | NY |
N | 103TC1900X | Counseling Psychologist | 012527-01 | NY |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 012527-01 | NY |
N | 103TF0000X | Family Psychologist | 012527-1 | NY |
N | 103TF0200X | Forensic Psychologist | 012527-1 | NY |
N | 103TH0100X | Health Service | 012527-1 | NY |
N | 103TM1800X | Intellectual & Developmental Disabilities | 012527-1 | NY |
N | 103TP0814X | Psychoanalysis | 012527-1 | NY |
N | 103TP2701X | Group Psychotherapist | 012527-1 | NY |
N | 103TS0200X | School Psychologist | 012527-1 | NY |
NPI | 1124247283 |
---|---|
Provider Name | Dr. Nancy Mina Freeman-Carroll |
First Address | New York, NY 10025-6547 |
Second Address | New York, NY 10025-6547 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2007 |
Last Update Date | 26/01/2011 |