Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 013925-1 | NY |
N | 103T00000X | Psychologist | 013925-1 | NY |
Y | 103TA0700X | Adult Development & Aging Psychologist | 013925-1 | NY |
NPI | 1396922704 |
---|---|
Provider Name | Marjorie K Dennin |
First Address | Selkirk, NY 12158-9740 |
Second Address | Delmar, NY 12054-2221 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2008 |
Last Update Date | 28/01/2008 |