Healthcare Provider Details

I. General information

NPI: 1780093773
Provider Name (Legal Business Name): MEGAN ICE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2014
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 E 50TH ST
NEW YORK NY
10022-7701
US

IV. Provider business mailing address

115 E 34TH ST APT 19E
NEW YORK NY
10016-4777
US

V. Phone/Fax

Practice location:
  • Phone: 646-561-9951
  • Fax:
Mailing address:
  • Phone: 914-329-8523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number11595
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSO2372
License Number StateRI
# 4
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number027054
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: