Provider Demographics
NPI:1346373123
Name:CORNELIUS, CHERYL BRANDT (PHD IN PSYCHOLOGY)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:BRANDT
Last Name:CORNELIUS
Suffix:
Gender:F
Credentials:PHD IN PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 91
Mailing Address - Street 2:
Mailing Address - City:HUNTER
Mailing Address - State:NY
Mailing Address - Zip Code:12442-0091
Mailing Address - Country:US
Mailing Address - Phone:518-263-3985
Mailing Address - Fax:
Practice Address - Street 1:16 EAST 41ST ST
Practice Address - Street 2:4D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-6217
Practice Address - Country:US
Practice Address - Phone:212-689-4946
Practice Address - Fax:212-481-0344
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010314103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV73261Medicare ID - Type Unspecified