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NPI Code Detail

MEDICARE: DR. COURTNEY ANNE DE THOMAS PH.D.

MEDICARE: DR. COURTNEY ANNE DE THOMAS 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
1103TC0700XClinical Psychologist019267NY

General Provider Information

NPI Number : 1891166724
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. COURTNEY ANNE DE THOMAS PH.D.
Provider Business Mailing Address
First Line : 595 GERARD AVE
Second Line : NEW YORK CITY CHILDREN'S CENTER- BRONX CAMPUS
City : BRONX
State : NY
Zip : 10451-5239
Country : US
Telephone Number : 718-742-6185
Fax Number : 718-742-6016
Provider Business Practice Location Address
First Line : 595 GERARD AVE
Second Line : NEW YORK CITY CHILDREN'S CENTER- BRONX CAMPUS
City : BRONX
State : NY
Zip : 10451-5239
Country : US
Telephone Number : 718-742-6185
Fax Number : 718-742-6016
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/19/2015
Last Update Date : 10/19/2015

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