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General NPI Number Information
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NPI Number | 1295067544
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Entity Type | Individual
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Provider Name | JUDITH SUSAN GEIZHALS PHD
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Gender | Female
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Dates
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Enumeration Date | 02/10/2010
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Last Update Date | 05/07/2014
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Provider Practice Location Address
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Address Line | 505 NORTHERN BLVD SUITE215
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City | GREAT NECK
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State | NY
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Zip | 11021-5115
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Country | US
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Telephone | 516-993-3319
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Fax |
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Provider Business Mailing Address
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Address Line | 8 BARSTOW RD APT 2D
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City | GREAT NECK
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State | NY
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Zip | 11021-3544
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Country | US
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Telephone | 516-993-3319
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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 | 006961-1
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License Number State | NY
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