Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 35S100563100 | NJ |
Y | 103T00000X | Psychologist | 35S100563100 | NJ |
NPI | 1003370693 |
---|---|
Provider Name | Ellen Herr-Israel |
First Address | Skillman, NJ 08558-1639 |
Second Address | Princeton, NJ 08540-2800 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2019 |
Last Update Date | 28/01/2019 |