Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 012268 | NY |
Y | 103T00000X | Psychologist | 012268 | NY |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 012268 | NY |
NPI | 1053525758 |
---|---|
Provider Name | William Ansorge |
First Address | New York, NY 10023-2413 |
Second Address | New York, NY 10023-2413 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2007 |
Last Update Date | 06/10/2011 |