Healthcare Provider Details

I. General information

NPI: 1407168495
Provider Name (Legal Business Name): CAMILLA ZOE CUDDY PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2010
Last Update Date: 07/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 E END AVE APARTMENT 16B
NEW YORK NY
10128-7763
US

IV. Provider business mailing address

180 E END AVE APARTMENT 16B
NEW YORK NY
10128-7763
US

V. Phone/Fax

Practice location:
  • Phone: 917-912-6667
  • Fax:
Mailing address:
  • Phone: 917-912-6667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number015985-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: