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General NPI Number Information
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NPI Number | 1336490382
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Entity Type | Individual
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Provider Name | RACHELLE SILVER THEISE
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Gender | Female
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Dates
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Enumeration Date | 09/29/2012
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Last Update Date | 02/07/2013
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Provider Practice Location Address
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Address Line | 1 PARK AVE
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City | NEW YORK
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State | NY
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Zip | 10016-5802
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Country | US
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Telephone | 646-754-4978
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Fax |
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Provider Business Mailing Address
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Address Line | 1 PARK AVE
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City | NEW YORK
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State | NY
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Zip | 10016-5802
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Country | US
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Telephone | 646-754-4978
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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 | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | 019812-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 019812-1
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License Number State | NY
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