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General NPI Number Information
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NPI Number | 1871915199
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Entity Type | Organization
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Legal Business Name | CMD PSYCHOLOGICAL SERVICES PLLC
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Dates
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Enumeration Date | 01/07/2014
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Last Update Date | 01/07/2014
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Provider Practice Location Address
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Address Line | 125 SPENCER PL
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City | MAMARONECK
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State | NY
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Zip | 10543-5601
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Country | US
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Telephone | 914-874-7225
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Fax |
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Provider Business Mailing Address
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Address Line | 63 MCGEORY AVE
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City | BRONXVILLE
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State | NY
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Zip | 10708-6618
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Country | US
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Telephone | 914-874-7225
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | CHRISTINA DOHERTY
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Credential | PHD
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Telephone | 914-874-7225
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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 | 019805
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License Number State | NY
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