Organization
EMORYS ANNEX
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY BETH SIVAK PHD (CEO)
(917) 601-9029
Entity
Organization
Contact information
Practice address
7523 168TH ST, FRESH MEADOWS, NY 11366-1331
(917) 601-9029
Mailing address
7523 168TH ST, FRESH MEADOWS, NY 11366-1331
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
—
—
Other
Enumeration date
10/18/2023
Last updated
10/18/2023
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