Provider Demographics
NPI:1326678145
Name:LI, VANESSA (PHD)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:LI
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 1:165 W 91ST ST APT 7A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-1356
Mailing Address - Country:US
Mailing Address - Phone:401-965-6306
Mailing Address - Fax:
Practice Address - Street 1:115 W 30TH ST RM 709
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-4068
Practice Address - Country:US
Practice Address - Phone:646-626-6640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-21
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY23594103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist