Healthcare Provider Details

I. General information

NPI: 1770782427
Provider Name (Legal Business Name): AUDREY ALTON PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

942 5TH AVE
NEW YORK NY
10021-2656
US

IV. Provider business mailing address

108 E 82ND ST APT 5B
NEW YORK NY
10028-1137
US

V. Phone/Fax

Practice location:
  • Phone: 917-623-0254
  • Fax:
Mailing address:
  • Phone: 917-623-0254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number012015
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: