Provider Demographics
NPI:1366475311
Name:WATRAS-GANS, SNIEZYNA (PHD)
Entity Type:Individual
Prefix:
First Name:SNIEZYNA
Middle Name:
Last Name:WATRAS-GANS
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 1:425 RIVERSIDE DR
Mailing Address - Street 2:APT 11A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-7775
Mailing Address - Country:US
Mailing Address - Phone:212-864-0639
Mailing Address - Fax:212-864-0639
Practice Address - Street 1:585 SCHENECTADY AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-1809
Practice Address - Country:US
Practice Address - Phone:718-604-5829
Practice Address - Fax:718-604-5527
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013927-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02070822Medicaid
NY02070822Medicaid