Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | NY |
NPI | 1063794030 |
---|---|
Provider Name | Ms. Moira Beth Citko |
First Address | Sea Cliff, NY 11579-1833 |
Second Address | Sea Cliff, NY 11579-1833 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2011 |
Last Update Date | 15/09/2011 |