Provider Demographics
NPI:1154472660
Name:LANDES, ARLENE A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ARLENE
Middle Name:A
Last Name:LANDES
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E 47TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-2302
Mailing Address - Country:US
Mailing Address - Phone:212-935-1467
Mailing Address - Fax:
Practice Address - Street 1:301 E 47TH ST
Practice Address - Street 2:2A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-2302
Practice Address - Country:US
Practice Address - Phone:212-935-1467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009868103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR53679Medicare UPIN
NYV72601Medicare ID - Type Unspecified