Healthcare Provider Details

I. General information

NPI: 1629170758
Provider Name (Legal Business Name): TODD SENZON M.A., L.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 02/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 BROADWAY STE 514
NEW YORK NY
10010-8181
US

IV. Provider business mailing address

1133 BROADWAY STE 514
NEW YORK NY
10010-8181
US

V. Phone/Fax

Practice location:
  • Phone: 917-673-2710
  • Fax:
Mailing address:
  • Phone: 917-673-2710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License Number19000095
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: