Organization
HERALD SQUARE PSYCHOLOGY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TYSON A. FURR PH.D (OWNER)
(646) 602-0149
Entity
Organization
Contact information
Practice address
19 W 34TH ST PH, NEW YORK, NY 10001
(646) 602-0149
Mailing address
19 W 34TH ST PH, NEW YORK, NY 10001-3006
(646) 602-0149
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
018787
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
018787
NY STATE LICENSE
NY
Enumeration date
08/22/2016
Last updated
08/06/2018
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