Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103K00000X | Behavior Analyst | 1-10-7776 | |
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 023180 | NY |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 3814 | CT |
NPI | 1164795316 |
---|---|
Provider Name | Kelly Workman |
First Address | New York, NY 10019-6113 |
Second Address | New York, NY 10019 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2012 |
Last Update Date | 05/08/2019 |