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General NPI Number Information
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NPI Number | 1053861625
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Entity Type | Individual
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Provider Name | TIFFANY HOUCK-LOOMIS M.DIV., PH.D., L.P.
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Gender | Female
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Dates
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Enumeration Date | 10/07/2016
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Last Update Date | 10/03/2019
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Provider Practice Location Address
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Address Line | 26 W 9TH ST APT 10A
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City | NEW YORK
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State | NY
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Zip | 10011-8920
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Country | US
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Telephone | 917-232-7232
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Fax |
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Provider Business Mailing Address
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Address Line | 26 W 9TH ST APT 10A
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City | NEW YORK
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State | NY
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Zip | 10011-8920
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Country | US
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Telephone | 917-232-7232
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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 | 102L00000X
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Taxonomy Name | Psychoanalyst
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License Number | 001055
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License Number State | NY
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