Provider Demographics
NPI:1134312572
Name:RAY MAZUMDER, SHIBANI (PHD, SCD)
Entity Type:Individual
Prefix:DR
First Name:SHIBANI
Middle Name:
Last Name:RAY MAZUMDER
Suffix:
Gender:F
Credentials:PHD, SCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:466 W 153RD ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-1101
Mailing Address - Country:US
Mailing Address - Phone:631-786-9312
Mailing Address - Fax:
Practice Address - Street 1:250 E 30TH ST APT 9A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-8298
Practice Address - Country:US
Practice Address - Phone:631-786-9312
Practice Address - Fax:212-263-8995
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-20
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020691103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth