Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 020427 | NY |
NPI | 1093137598 |
---|---|
Provider Name | Jaclyn Ghamar |
First Address | New York, NY 10021-5223 |
Second Address | New York, NY 10021-5223 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2014 |
Last Update Date | 17/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
020427 | PSYCHOLOGIST LICENSE (01) | NY |