Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 013005-01 | NY |
Y | 103TC0700X | Clinical Psychologist | 013005-01 | NY |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 013005-01 | NY |
NPI | 1093346496 |
---|---|
Provider Name | Nicole Marcus |
First Address | New York, NY 10023-5540 |
Second Address | New York, NY 10023-5540 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2020 |
Last Update Date | 04/02/2020 |