Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | PSY 5042 | NY |
Y | 103G00000X | Clinical Psychologist | PSY 5042 | NY |
Y | 103TC0700X | Clinical Psychologist | PSY 5042 | NY |
NPI | 1154629517 |
---|---|
Provider Name | Ellen Tobey Klass |
First Address | New York, NY 10011-5715 |
Second Address | New York, NY 10011-5715 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2011 |
Last Update Date | 09/03/2011 |