Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | ||
N | 103T00000X | Psychologist | ||
Y | 102L00000X | Psychologist | 013329 | NY |
Y | 103T00000X | Psychologist | 013329 | NY |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 013329 | NY |
NPI | 1043827678 |
---|---|
Provider Name | Paul Lichtenberg |
First Address | Accord, NY 12404-5516 |
Second Address | Accord, NY 12404-5516 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2020 |
Last Update Date | 28/09/2020 |