Provider Demographics
NPI:1477950624
Name:CREELMAN, MONICA L (PHD)
Entity Type:Individual
Prefix:DR
First Name:MONICA
Middle Name:L
Last Name:CREELMAN
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 1:560 BROADWAY RM 510
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-3946
Mailing Address - Country:US
Mailing Address - Phone:212-924-8937
Mailing Address - Fax:212-924-8937
Practice Address - Street 1:560 BROADWAY RM 510
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-3946
Practice Address - Country:US
Practice Address - Phone:212-924-8937
Practice Address - Fax:212-924-8937
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-02
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014921-1103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist