=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184123598
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RACHEL L SIFRY PHD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/12/2018
-----------------------------------------------------
Last Update Date | 02/12/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 210 W 70TH ST APT 201
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10023-4363
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-244-4424
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4 LEXINGTON CT
-----------------------------------------------------
City | PRINCETON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08540-7813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-363-6333
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 13014-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------