Individual
ANGEL THEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
566 7TH AVE FL 4, NEW YORK, NY 10018-1802
(212) 564-7631
Mailing address
601 W 177TH ST APT 62, NEW YORK, NY 10033-7152
(347) 883-9376
Taxonomy
Speciality
Code
Description
License number
State
103TF0200X
Forensic Psychologist
Primary
012747-1
NY
Other
Enumeration date
02/12/2020
Last updated
02/12/2020
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