Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | NY | |
Y | 103TB0200X | Cognitive & Behavioral Psychologist | NY | |
N | 103TC1900X | Counseling Psychologist | NY | |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | NY | |
N | 103TF0000X | Family Psychologist | NY | |
N | 103TH0004X | Health Psychologist | NY | |
N | 103TP2701X | Group Psychotherapist | NY |
NPI | 1053078444 |
---|---|
Provider Name | Kimberly M Persaud |
First Address | Brooklyn, NY 11208-4407 |
Second Address | New York, NY 10010-4559 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2021 |
Last Update Date | 21/11/2021 |