Individual
MIEL NORWOOD FAJEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ED.D.
Contact information
Practice address
475 WATERVLIET SHAKER RD, LATHAM, NY 12110-4622
(518) 785-1341
Mailing address
317 COUNTY ROUTE 7, NASSAU, NY 12123-3132
(518) 785-1341
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
020859
NY
Other
Enumeration date
09/18/2014
Last updated
09/18/2014
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