Healthcare Provider Details

I. General information

NPI: 1003779349
Provider Name (Legal Business Name): PRINCESS EZEANOCHIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

442 5TH AVE # 2101
NEW YORK NY
10018-2794
US

IV. Provider business mailing address

6271 OXON HILL RD APT 302
OXON HILL MD
20745-3084
US

V. Phone/Fax

Practice location:
  • Phone: 877-777-9711
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberP126235
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: