Provider Demographics
NPI:1457667982
Name:GEVA-GROFMAN, DANA (PHD)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:
Last Name:GEVA-GROFMAN
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 1:350 E 82ND ST
Mailing Address - Street 2:14D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-4909
Mailing Address - Country:US
Mailing Address - Phone:646-369-5862
Mailing Address - Fax:
Practice Address - Street 1:115 E 86TH ST
Practice Address - Street 2:SUITE 4
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-1057
Practice Address - Country:US
Practice Address - Phone:646-369-5862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-21
Last Update Date:2012-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY68018733103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical