MEDICARE: DR. STEVEN LOUIS DEMBY PH,D,

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	006585	NY
2	103TC2200X	Clinical Child & Adolescent Psychologist	006585	NY
3	103TF0200X	Forensic Psychologist	006585	NY

General Provider Information

NPI Number	:	1164689246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN LOUIS DEMBY PH,D,

Provider Business Mailing Address
First Line	:	465 HENRY ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11231-3011
Country	:	US
Telephone Number	:	718-797-2683
Fax Number	:	718-797-2683

Provider Business Practice Location Address
First Line	:	465 HENRY ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11231-3011
Country	:	US
Telephone Number	:	718-797-2683
Fax Number	:	718-797-2683

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2008
Last Update Date	:	05/17/2008

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