Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | R021936-1 | NY |
NPI | 1083842942 |
---|---|
Provider Name | Marc Wayne |
First Address | New York, NY 10011-6822 |
Second Address | New York, NY 10011-6822 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2009 |
Last Update Date | 30/06/2009 |