Provider Demographics
NPI:1225172497
Name:ARCHIBALD, ELOISE MARY (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELOISE
Middle Name:MARY
Last Name:ARCHIBALD
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 1:100 OVERLOOK TER
Mailing Address - Street 2:#519
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-3852
Mailing Address - Country:US
Mailing Address - Phone:212-568-0509
Mailing Address - Fax:
Practice Address - Street 1:100 OVERLOOK TER
Practice Address - Street 2:#519
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-3852
Practice Address - Country:US
Practice Address - Phone:212-568-0509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006535-1103TC0700X, 103TF0200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist