Healthcare Provider Details

I. General information

NPI: 1235250564
Provider Name (Legal Business Name): APRIL KUCHUK PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 CENTRAL PARK W 1 E
NEW YORK NY
10024-4530
US

IV. Provider business mailing address

100 BLEECKER ST 24F
NEW YORK NY
10012-2202
US

V. Phone/Fax

Practice location:
  • Phone: 212-787-5777
  • Fax:
Mailing address:
  • Phone: 212-982-1212
  • Fax: 212-982-1212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number8209-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: