Healthcare Provider Details

I. General information

NPI: 1861677965
Provider Name (Legal Business Name): JUDITH MARGALIT SAMBOL PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2008
Last Update Date: 01/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 W 95TH ST APT 1D
NEW YORK NY
10025-6612
US

IV. Provider business mailing address

215 W 95TH ST APT 8R
NEW YORK NY
10025-6355
US

V. Phone/Fax

Practice location:
  • Phone: 917-301-4099
  • Fax:
Mailing address:
  • Phone: 917-301-4099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number017256
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number017256
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number017256
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: