MEDICARE: DR. CHERYL ANN CARD 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	011056-1	NY

General Provider Information

NPI Number	:	1861748915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHERYL ANN CARD PH.D.

Provider Business Mailing Address
First Line	:	29 LAKE SHORE DR
Second Line	:
City	:	SOUTH SALEM
State	:	NY
Zip	:	10590-1311
Country	:	US
Telephone Number	:	914-763-5384
Fax Number	:

Provider Business Practice Location Address
First Line	:	29 LAKE SHORE DR
Second Line	:
City	:	SOUTH SALEM
State	:	NY
Zip	:	10590-1311
Country	:	US
Telephone Number	:	914-763-5384
Fax Number	:

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

Provider Enumeration Date	:	07/26/2012
Last Update Date	:	07/26/2012

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