Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 2195844 | NY |
NPI | 1053690305 |
---|---|
Provider Name | Olivia Mary Pine |
First Address | New York, NY 10009-5747 |
Second Address | New York, NY 10009-5747 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2011 |
Last Update Date | 04/08/2011 |