Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | 667P27302 | NY |
N | 102L00000X | Psychologist | 667P27302 | NY |
N | 103T00000X | Psychologist | 667P27302 | NY |
NPI | 1003186768 |
---|---|
Provider Name | Mr. Elliot Resnick |
First Address | New Rochelle, NY 10804 |
Second Address | New Rochelle, NY 10804 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2012 |
Last Update Date | 11/01/2012 |