Healthcare Provider Details

I. General information

NPI: 1982706479
Provider Name (Legal Business Name): JOHN DRAPER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 BARROW ST
NEW YORK NY
10014-3823
US

IV. Provider business mailing address

666 BROADWAY 2ND FLOOR
NEW YORK NY
10012-2317
US

V. Phone/Fax

Practice location:
  • Phone: 646-872-7119
  • Fax:
Mailing address:
  • Phone: 646-872-7119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number013853
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: