Provider Demographics
NPI:1093980468
Name:HULLOT-KENTOR, ODILE M (PHD)
Entity Type:Individual
Prefix:
First Name:ODILE
Middle Name:M
Last Name:HULLOT-KENTOR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 W 12TH ST APT 1B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-8530
Mailing Address - Country:US
Mailing Address - Phone:212-591-0056
Mailing Address - Fax:212-787-0430
Practice Address - Street 1:49 W 12TH ST APT 1B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8530
Practice Address - Country:US
Practice Address - Phone:212-591-0056
Practice Address - Fax:212-787-0430
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000576102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst