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NPI Code Detail

MEDICARE: DR. CHERYL BRANDT CORNELIUS PHD IN PSYCHOLOGY

MEDICARE: DR. CHERYL BRANDT CORNELIUS PHD IN PSYCHOLOGY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist010314NY

General Provider Information

NPI Number : 1346373123
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHERYL BRANDT CORNELIUS PHD IN PSYCHOLOGY
Provider Business Mailing Address
First Line : PO BOX 91
Second Line :
City : HUNTER
State : NY
Zip : 12442-0091
Country : US
Telephone Number : 518-263-3985
Fax Number :
Provider Business Practice Location Address
First Line : 16 EAST 41ST ST
Second Line : 4D
City : NEW YORK
State : NY
Zip : 10017-6217
Country : US
Telephone Number : 212-689-4946
Fax Number : 212-481-0344
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/13/2007
Last Update Date : 07/08/2007

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