MEDICARE: DAISY EDMONDSON ALTER 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	103T00000X	Psychologist	015375	NY

General Provider Information

NPI Number	:	1588684385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAISY EDMONDSON ALTER PH.D.

Provider Business Mailing Address
First Line	:	154 SLOCUM CRES
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-5248
Country	:	US
Telephone Number	:	718-986-5258
Fax Number	:

Provider Business Practice Location Address
First Line	:	10923 71ST RD
Second Line	:	APARTMENT 1H
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-4849
Country	:	US
Telephone Number	:	718-986-5258
Fax Number	:

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

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	07/08/2007

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