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General NPI Number Information
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NPI Number | 1023341815
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Entity Type | Individual
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Provider Name | LAURA D'NELL EIDLITZ PHD
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Gender | Female
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Dates
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Enumeration Date | 09/10/2009
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Last Update Date | 07/10/2019
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Provider Practice Location Address
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Address Line | 286 5TH AVE 6K
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City | NEW YORK
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State | NY
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Zip | 10001
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Country | US
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Telephone | 646-460-2372
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Fax |
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Provider Business Mailing Address
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Address Line | 286 5TH AVE # 7K
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City | NEW YORK
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State | NY
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Zip | 10001-4512
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Country | US
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Telephone | 646-460-2372
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 18004305
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 18 0004308
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | P08602
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 023268
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License Number State | NY
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