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General NPI Number Information
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NPI Number | 1124425756
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Entity Type | Organization
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Legal Business Name | REFLECTIVE PSYCHOLOGY ASSOCIATES, PLLC
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Dates
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Enumeration Date | 11/25/2014
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Last Update Date | 11/25/2014
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Provider Practice Location Address
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Address Line | 144 WOODBURY RD 16
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City | WOODBURY
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State | NY
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Zip | 11797-1418
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Country | US
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Telephone | 516-900-2541
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Fax |
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Provider Business Mailing Address
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Address Line | 144 WOODBURY RD 16
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City | WOODBURY
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State | NY
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Zip | 11797-1418
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Country | US
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Telephone | 516-900-2541
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SALLY ANN GRAHAM
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Credential | PHD
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Telephone | 516-900-2541
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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 | 013953
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License Number State | NY
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