Individual
DR. JOHN L. THEODORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
412 AVENUE OF THE AMERICAS, SUITE 413, NEW YORK, NY 10011-8409
(646) 239-7774
(212) 388-1215
Mailing address
412 AVENUE OF THE AMERICAS, SUITE 413, NEW YORK, NY 10011-8409
(646) 239-7774
(212) 388-1215
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
68 017120
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02878408
—
NY
Enumeration date
04/19/2007
Last updated
12/21/2010
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