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General NPI Number Information
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NPI Number | 1033072178
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Entity Type | Individual
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Provider Name | KATIE BANNON TAYLOR PH.D.
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Gender | Female
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Dates
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Enumeration Date | 12/05/2025
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 200 S SERVICE RD
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City | ROSLYN HEIGHTS
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State | NY
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Zip | 11577-2126
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Country | US
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Telephone | 347-658-6124
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Fax |
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Provider Business Mailing Address
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Address Line | 122 E 82ND ST APT 2AB
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City | NEW YORK
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State | NY
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Zip | 10028-0822
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Country | US
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Telephone | 347-658-6124
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 027745
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License Number State | NY
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