Individual
MOIRA DOMAILLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
65 E 76TH ST STE 1B, NEW YORK, NY 10021-1844
(929) 266-7930
Mailing address
101 W 79TH ST APT 8A, NEW YORK, NY 10024-6475
(646) 441-0212
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
021502-1
NY
Other
Enumeration date
01/28/2016
Last updated
01/28/2016
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