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General NPI Number Information
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NPI Number | 1265644488
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Entity Type | Organization
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Legal Business Name | BARBARA BLACK KOLTUV PH.D. PSYCHOLOGIST PC
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2 FIFTH AVENUE 2A
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City | NEW YORK
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State | NY
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Zip | 10011-8856
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Country | US
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Telephone | 212-982-6707
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Fax |
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Provider Business Mailing Address
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Address Line | 2 FIFTH AVENUE 2A
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City | NEW YORK
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State | NY
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Zip | 10011-8856
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Country | US
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Telephone | 212-982-6707
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BARBARA BLACK KOLTUV
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Credential | PH.D.
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Telephone | 212-982-6707
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | PSYCHOLOGIST 2950
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License Number State | NY
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