Healthcare Provider Details

I. General information

NPI: 1871915199
Provider Name (Legal Business Name): CMD PSYCHOLOGICAL SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2014
Last Update Date: 01/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 SPENCER PL
MAMARONECK NY
10543-5601
US

IV. Provider business mailing address

63 MCGEORY AVE
BRONXVILLE NY
10708-6618
US

V. Phone/Fax

Practice location:
  • Phone: 914-874-7225
  • Fax:
Mailing address:
  • Phone: 914-874-7225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number019805
License Number StateNY

VIII. Authorized Official

Name: CHRISTINA DOHERTY
Title or Position: SOLE MEMBER
Credential: PHD
Phone: 914-874-7225