Provider Demographics
NPI:1467042911
Name:FALL, NDOUMBE
Entity Type:Individual
Prefix:
First Name:NDOUMBE
Middle Name:
Last Name:FALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 HUDSON STREET 5TH FLOOR
Mailing Address - Street 2:#7303
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-2993
Mailing Address - Country:US
Mailing Address - Phone:646-694-0406
Mailing Address - Fax:
Practice Address - Street 1:99 HUDSON STREET 5TH FLOOR
Practice Address - Street 2:#7303
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-2993
Practice Address - Country:US
Practice Address - Phone:646-694-0406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-19
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health