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General NPI Number Information
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NPI Number | 1174233746
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Entity Type | Individual
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Provider Name | VANESSA DZMUROVA
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Gender | Female
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Dates
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Enumeration Date | 12/05/2022
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Last Update Date | 12/05/2022
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Provider Practice Location Address
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Address Line | 41 UNION SQ W STE 1328
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City | NEW YORK
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State | NY
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Zip | 10003-3252
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Country | US
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Telephone | 516-382-5440
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Fax |
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Provider Business Mailing Address
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Address Line | STECHOVICKA 3468/2 APT B-201
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City | PRAGUE
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State | CZECH REPUBLIC
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Zip | 100 00
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Country | CZ
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Telephone |
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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