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General NPI Number Information
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NPI Number | 1487790259
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Entity Type | Individual
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Provider Name | CECILIA O EUSTACE PSY D
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Gender | Female
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7 FARESE WAY
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City | AMAWALK
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State | NY
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Zip | 10501-1201
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Country | US
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Telephone | 914-962-3348
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Fax | 914-962-4332
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Provider Business Mailing Address
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Address Line | PO BOX 611
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City | YORKTOWN HTS
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State | NY
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Zip | 10598-0611
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Country | US
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Telephone | 914-962-3348
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Fax | 914-962-4332
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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 | 0085561
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License Number State | NY
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