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General NPI Number Information
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NPI Number | 1134314867
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Entity Type | Individual
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Provider Name | MARTINE LILIANE VAN MILDERS PH.D.
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Gender | Female
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Dates
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Enumeration Date | 09/06/2007
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Last Update Date | 09/06/2007
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Provider Practice Location Address
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Address Line | 1841 BROADWAY 4TH FLOOR
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City | NEW YORK
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State | NY
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Zip | 10023-7603
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Country | US
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Telephone | 212-541-8196
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Fax | 212-333-5444
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Provider Business Mailing Address
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Address Line | 343 JOHNSTON DR
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City | WATCHUNG
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State | NJ
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Zip | 07069-6409
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Country | US
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Telephone | 908-727-2700
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Fax | 908-757-2954
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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 | 012650
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License Number State | NY
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