MEDICARE: MIGUEL HUMARA PH.D.

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
1	103TC0700X	Clinical Psychologist	15419	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578577797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIGUEL HUMARA PH.D.

Provider Business Mailing Address
First Line	:	1142 1ST AVE
Second Line	:	#11
City	:	NEW YORK
State	:	NY
Zip	:	10021-7959
Country	:	US
Telephone Number	:	917-476-0670
Fax Number	:

Provider Business Practice Location Address
First Line	:	910 W END AVE
Second Line	:	#1C
City	:	NEW YORK
State	:	NY
Zip	:	10025-3533
Country	:	US
Telephone Number	:	212-851-8100
Fax Number	:	212-932-0964

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	07/08/2007

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