MEDICARE: DR. NADINE FITOUSSI PSY.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	103TS0200X	School Psychologist	019215	NY

General Provider Information

NPI Number	:	1649547464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NADINE FITOUSSI PSY.D.

Provider Business Mailing Address
First Line	:	101 SANDS POINT RD
Second Line	:	SOUSA ELEMENTARY SCHOOL
City	:	PORT WASHINGTON
State	:	NY
Zip	:	11050-1641
Country	:	US
Telephone Number	:	516-767-5361
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 SANDS POINT RD
Second Line	:	SOUSA ELEMENTARY SCHOOL
City	:	PORT WASHINGTON
State	:	NY
Zip	:	11050-1641
Country	:	US
Telephone Number	:	516-767-5361
Fax Number	:

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

Provider Enumeration Date	:	11/22/2011
Last Update Date	:	11/22/2011

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