Healthcare Provider Details

I. General information

NPI: 1194339820
Provider Name (Legal Business Name): EDEN SHERMAN PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2020
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

369 LEXINGTON AVE RM 14A
NEW YORK NY
10017-6526
US

IV. Provider business mailing address

369 LEXINGTON AVE RM 14A
NEW YORK NY
10017-6526
US

V. Phone/Fax

Practice location:
  • Phone: 212-204-8430
  • Fax:
Mailing address:
  • Phone: 212-204-8430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number028301
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: