=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265983407
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAURA PRICE PHD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2016
-----------------------------------------------------
Last Update Date | 10/24/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 303 5TH AVE SUITE 403
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10016-6601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-984-2576
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 25 BROAD ST APT. 8G
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10004-2517
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-984-2576
-----------------------------------------------------
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 | 021651
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------