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General NPI Number Information
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NPI Number | 1487890026
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Entity Type | Individual
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Provider Name | MARIA XYDAS PH. D.
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Gender | Female
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Dates
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Enumeration Date | 01/04/2009
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Last Update Date | 01/20/2009
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Provider Practice Location Address
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Address Line | 1035 ROUTE 106
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City | EAST NORWICH
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State | NY
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Zip | 11732
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Country | US
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Telephone | 516-967-0348
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Fax |
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Provider Business Mailing Address
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Address Line | 90 WOODCHUCK HOLLOW RD
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City | COLD SPRING HARBOR
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State | NY
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Zip | 11724-2437
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Country | US
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Telephone | 516-967-0348
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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 | 014691-1
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License Number State | NY
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