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General NPI Number Information
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NPI Number | 1629747613
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Entity Type | Individual
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Provider Name | GABRIELLA NISSAN PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 09/13/2021
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Last Update Date | 11/08/2024
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Provider Practice Location Address
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Address Line | 184 E 70TH ST STE 5
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City | NEW YORK
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State | NY
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Zip | 10021-5154
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Country | US
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Telephone | 646-580-5845
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Fax |
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Provider Business Mailing Address
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Address Line | 219 E 69TH ST APT 3M
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City | NEW YORK
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State | NY
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Zip | 10021-0022
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Country | US
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Telephone |
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 35SI00724100
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 025770
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License Number State | NY
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