Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | 000281-1 | NY |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 000281-1 | NY |
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 000281-1 | NY |
N | 103TR0400X | Rehabilitation Psychologist | 000281-1 | NY |
NPI | 1548324593 |
---|---|
Provider Name | Jane Elliott S Desouza |
First Address | Harrison, NY 10528-1524 |
Second Address | Harrison, NY 10528-1524 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2006 |
Last Update Date | 01/10/2009 |