Healthcare Provider Details

I. General information

NPI: 1174744049
Provider Name (Legal Business Name): DONNA KATHY NISSMAN PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

353 LEXINGTON AVE RM 400
NEW YORK NY
10016-1054
US

IV. Provider business mailing address

353 LEXINGTON AVE RM 400
NEW YORK NY
10016-1054
US

V. Phone/Fax

Practice location:
  • Phone: 631-889-3307
  • Fax:
Mailing address:
  • Phone: 631-889-3307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0117691
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: