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General NPI Number Information
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NPI Number | 1154656098
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Entity Type | Individual
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Provider Name | DOMINIQUE MORISANO PH.D., CPSYCH
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Gender | Female
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Dates
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Enumeration Date | 10/09/2009
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Last Update Date | 05/16/2023
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Provider Practice Location Address
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Address Line | 1090 AMSTERDAM AVE SUITE 17TH FLOOR (SOUTH)
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City | NEW YORK
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State | NY
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Zip | 10025-1737
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Country | US
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Telephone | 212-523-2596
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Fax | 212-523-3642
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Provider Business Mailing Address
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Address Line | 442 5TH AVE # 2275
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City | NEW YORK
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State | NY
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Zip | 10018-2794
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Country | US
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Telephone | 855-649-2150
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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 | 018327
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 018327
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License Number State | NY
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