=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598234817
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DIANE BRITTON PHD PSYCHOLOGY PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2018
-----------------------------------------------------
Last Update Date | 11/15/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 506 6TH ST
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11215-3609
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-807-0245
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 96 5TH AVE APT 18C
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10011-7625
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-807-0245
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/ CLINICAL PSYCHOLOGIST
-----------------------------------------------------
Name | DIANE BRITTON
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 212-807-0245
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------