Healthcare Provider Details

I. General information

NPI: 1124232541
Provider Name (Legal Business Name): CLAUDIA JOY KOBLENZ-SULCOV PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CLAUDIA JOY KOBLENZ PHD

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 MILLWOOD RD
CHAPPAQUA NY
10514-1100
US

IV. Provider business mailing address

375 MILLWOOD RD
CHAPPAQUA NY
10514-1100
US

V. Phone/Fax

Practice location:
  • Phone: 914-242-9324
  • Fax: 914-242-9324
Mailing address:
  • Phone: 914-242-9324
  • Fax: 914-242-9324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number007014
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: