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General NPI Number Information
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NPI Number | 1003241225
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Entity Type | Organization
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Legal Business Name | MAXINE L. GANN PSYCHOLOGIST, P.C.
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Dates
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Enumeration Date | 09/06/2013
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Last Update Date | 09/06/2013
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Provider Practice Location Address
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Address Line | 1199 PARK AVE SUITE 1K
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City | NEW YORK
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State | NY
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Zip | 10128-1711
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Country | US
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Telephone | 212-860-3368
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Fax | 212-202-3890
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Provider Business Mailing Address
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Address Line | 8 E 96TH ST SUITE 5A
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City | NEW YORK
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State | NY
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Zip | 10128-0706
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Country | US
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Telephone | 212-860-3368
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Fax | 212-202-3890
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MAXINE L. GANN
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Credential | PH.D.
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Telephone | 212-860-3368
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 7966
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 103TP0814X
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Taxonomy Name | Psychoanalysis Psychologist
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License Number | 7966
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 7966
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License Number State | NY
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