Healthcare Provider Details

I. General information

NPI: 1285225722
Provider Name (Legal Business Name): PAUL R NELSON LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2021
Last Update Date: 07/14/2021
Certification Date: 07/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 3RD AVE
NEW YORK NY
10017-6706
US

IV. Provider business mailing address

633 3RD AVE STE 9B
NEW YORK NY
10017-6706
US

V. Phone/Fax

Practice location:
  • Phone: 914-997-4100
  • Fax:
Mailing address:
  • Phone: 646-535-3133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number011034
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: