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General NPI Number Information
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NPI Number | 1861509028
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Entity Type | Individual
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Provider Name | DEIDRE ANGLIN PHD
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Gender | Female
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Dates
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Enumeration Date | 08/24/2006
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Last Update Date | 06/15/2009
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Provider Practice Location Address
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Address Line | 138 W 25TH ST 6TH FLOOR, #3
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City | NEW YORK
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State | NY
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Zip | 10001-7405
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Country | US
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Telephone | 917-860-5533
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Fax |
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Provider Business Mailing Address
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Address Line | 233 BAY ST APT. 201
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City | JERSEY CITY
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State | NJ
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Zip | 07302-5817
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Country | US
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Telephone | 917-860-5533
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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 | 016058
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License Number State | NY
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