Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 1125761 | NY |
NPI | 1073826376 |
---|---|
Provider Name | Ms. Elissa Dua |
First Address | Flushing, NY 11354-1436 |
Second Address | Fresh Meadows, NY 11365-3767 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2010 |
Last Update Date | 15/07/2010 |