Provider Demographics
NPI:1417234139
Name:NATHAN, VICKY (LCSW)
Entity Type:Individual
Prefix:
First Name:VICKY
Middle Name:
Last Name:NATHAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 ECHO BAY PLACE
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10805
Mailing Address - Country:US
Mailing Address - Phone:914-939-1177
Mailing Address - Fax:914-939-1168
Practice Address - Street 1:425 E 86TH ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-6449
Practice Address - Country:US
Practice Address - Phone:212-423-9189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY078766-1102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst