Provider Demographics
NPI:1003032780
Name:KOSE, MIRIAM K (M,S,, NCPSYA)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:K
Last Name:KOSE
Suffix:
Gender:F
Credentials:M,S,, NCPSYA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 W 74TH ST
Mailing Address - Street 2:7A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-2114
Mailing Address - Country:US
Mailing Address - Phone:212-595-4802
Mailing Address - Fax:
Practice Address - Street 1:244 W 74TH ST
Practice Address - Street 2:7A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-2114
Practice Address - Country:US
Practice Address - Phone:212-595-4802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000281102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000281OtherLICENSED PSYCHOANALYST
NYP 941299OtherCERTIFIED PSYCHOANALYST