=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356561203
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANNE C FLICK PSY.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/25/2007
-----------------------------------------------------
Last Update Date | 04/19/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 157 E 86TH ST SUITE 2A
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10028-2175
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-996-1732
-----------------------------------------------------
Fax | 212-517-3506
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 157 E 86TH ST SUITE 2A
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10028-2175
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-996-1732
-----------------------------------------------------
Fax | 212-517-3506
-----------------------------------------------------
=====================================================
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 | 008174-01
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------