Individual
DR. MANSOUR (MAX) BANILIVY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
2615 MERRICK AVE, MERRICK, NY 11566-4622
(516) 627-9432
(516) 867-0013
Mailing address
2615 MERRICK AVE, MERRICK, NY 11566-4622
(516) 627-9432
(516) 867-0013
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
007526
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00795840
—
NY
Enumeration date
08/05/2006
Last updated
07/08/2007
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