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General NPI Number Information
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NPI Number | 1487894077
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Entity Type | Individual
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Provider Name | CAROLYN ANN LICHT PH.D.
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Gender | Female
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Dates
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Enumeration Date | 02/23/2009
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Last Update Date | 04/17/2013
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Provider Practice Location Address
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Address Line | 7 W 86TH ST SUITE 1AA
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City | NEW YORK
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State | NY
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Zip | 10024-3603
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Country | US
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Telephone | 646-660-0884
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Fax | 646-304-6804
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Provider Business Mailing Address
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Address Line | 590 W END AVE APT. 2A
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City | NEW YORK
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State | NY
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Zip | 10024-1722
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Country | US
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Telephone | 646-660-0884
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Fax | 646-304-6804
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 017934
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License Number State | NY
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