Provider Demographics
NPI:1346325818
Name:PRUZANSKY, SHEILA ERLICH (MA PHD)
Entity Type:Individual
Prefix:DR
First Name:SHEILA
Middle Name:ERLICH
Last Name:PRUZANSKY
Suffix:
Gender:F
Credentials:MA PHD
Other - Prefix:DR
Other - First Name:SHEILA
Other - Middle Name:
Other - Last Name:ERLICH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA PHD
Mailing Address - Street 1:1095 PARK AVE #14C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128
Mailing Address - Country:US
Mailing Address - Phone:212-348-7094
Mailing Address - Fax:
Practice Address - Street 1:983 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028
Practice Address - Country:US
Practice Address - Phone:212-794-3879
Practice Address - Fax:212-794-3879
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011951103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY152078POtherHIP
NY152078POtherHIP