Healthcare Provider Details

I. General information

NPI: 1265566723
Provider Name (Legal Business Name): RICHARD PETER SLOAN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 SAINT NICHOLAS AVE SUITE 121
NEW YORK NY
10032-3822
US

IV. Provider business mailing address

1150 SAINT NICHOLAS AVE SUITE 121
NEW YORK NY
10032-3822
US

V. Phone/Fax

Practice location:
  • Phone: 212-851-5575
  • Fax:
Mailing address:
  • Phone: 212-851-5575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number4891134
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: