Individual
LILY BLANK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
910 W END AVE, #1C, NEW YORK, NY 10025-3533
(212) 851-8100
Mailing address
645 W END AVE, #6A, NEW YORK, NY 10025-7322
(917) 363-0004
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
14188
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02120414
—
NY
Enumeration date
07/26/2006
Last updated
10/24/2007
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