Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 8959 | NY |
NPI | 1124152491 |
---|---|
Provider Name | Emily Klass |
First Address | Glen Oaks, NY 11004 |
Second Address | Glen Oaks, NY 11004 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2007 |
Last Update Date | 08/07/2007 |