Organization
BOOMER PSYCHOLOGICAL SERVICES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BONNIE KELLEN PHD (PRESIDENT)
(212) 861-0740
Entity
Organization
Contact information
Practice address
201 E 77TH ST APT 16E, NEW YORK, NY 10075-2085
(212) 861-0740
Mailing address
201 E 77TH ST APT 16E, NEW YORK, NY 10075-2085
(212) 861-0740
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
011975
NY
Other
Enumeration date
10/04/2013
Last updated
10/04/2013
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