Healthcare Provider Details

I. General information

NPI: 1699898411
Provider Name (Legal Business Name): ALLISON GAYLE SITRIN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2007
Last Update Date: 06/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 W 25TH ST SUITE 802
NEW YORK NY
10001-7405
US

IV. Provider business mailing address

138 W 25TH ST SUITE 802
NEW YORK NY
10001-7405
US

V. Phone/Fax

Practice location:
  • Phone: 917-743-8204
  • Fax:
Mailing address:
  • Phone: 917-743-8204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number015896
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number015896
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number015896
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: