Individual
MAYIMUNA Y PETTIFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
214 W HOUSTON ST, NEW YORK, NY 10014-4846
(212) 337-9400
Mailing address
303 MERRICK RD, SUITE 204, LYNBROOK, NY 11563-2501
(800) 725-6280
(800) 725-6380
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
019680
NY
Other
Enumeration date
10/05/2012
Last updated
10/05/2012
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