Individual
DR. MICHAEL IVANOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
222 E 44TH ST APT 19K, NEW YORK, NY 10017-4453
(212) 602-1722
Mailing address
222 E 44TH ST APT 19K, NEW YORK, NY 10017-4453
(212) 602-1722
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
020355
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03809318
—
NY
01
—
5926
BIS
CA
Enumeration date
12/23/2006
Last updated
08/12/2025
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