Healthcare Provider Details

I. General information

NPI: 1396328134
Provider Name (Legal Business Name): RANDY P. NOLTE, PSY.D., PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2021
Last Update Date: 08/08/2022
Certification Date: 08/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 W 20TH ST STE 806
NEW YORK NY
10011-3716
US

IV. Provider business mailing address

37 W 20TH ST STE 806
NEW YORK NY
10011-3716
US

V. Phone/Fax

Practice location:
  • Phone: 212-256-1659
  • Fax:
Mailing address:
  • Phone: 212-256-1659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. RANDY NOLTE
Title or Position: CLINICAL PSYCHOLOGIST/DIRECTOR
Credential: PSYD
Phone: 212-256-1659