Healthcare Provider Details

I. General information

NPI: 1609945211
Provider Name (Legal Business Name): MARY BLANCHE COX PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 04/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

247 E. 82ND STREET SUITE 3
NEW YORK NY
10028
US

IV. Provider business mailing address

247 E. 82ND STREET SUITE 3
NEW YORK NY
10028
US

V. Phone/Fax

Practice location:
  • Phone: 212-734-3087
  • Fax:
Mailing address:
  • Phone: 212-734-3087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number004565
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number004565
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: