Healthcare Provider Details

I. General information

NPI: 1750507208
Provider Name (Legal Business Name): THELMA DELORES DYE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: THELMA DELORES DYE-HOLMES PH.D.

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 5TH AVE EXECUTIVE OFFICE NORTHSIDE CENTER FOR CHILD DEVELOP
NEW YORK NY
10029-3119
US

IV. Provider business mailing address

175 W 87TH ST 17C
NEW YORK NY
10024-2904
US

V. Phone/Fax

Practice location:
  • Phone: 212-426-3410
  • Fax: 212-426-8919
Mailing address:
  • Phone: 212-426-3411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number008554
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number008554
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number008554
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number008554
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: