Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | CASAC-17607 | NY |
Y | 102L00000X | Psychologist | 000920 | NY |
Y | 103T00000X | Psychologist | 000920 | NY |
NPI | 1003069352 |
---|---|
Provider Name | Juliane Maxwald-Shrey |
First Address | Long Island City, NY 11101-5604 |
Second Address | Long Island City, NY 11101-5711 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/10/2008 |
Last Update Date | 16/07/2014 |