Provider Demographics
NPI:1497270623
Name:TOMARKEN, ALEXIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:
Last Name:TOMARKEN
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 1:611 BROADWAY RM 520
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-2652
Mailing Address - Country:US
Mailing Address - Phone:646-515-4483
Mailing Address - Fax:212-777-4606
Practice Address - Street 1:611 BROADWAY RM 520
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-2652
Practice Address - Country:US
Practice Address - Phone:646-515-4483
Practice Address - Fax:212-777-4606
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019155-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY47-1755035OtherFEDERAL TAX ID NUMBER