Provider Demographics
NPI:1598173494
Name:LI, CLARA (PHD)
Entity Type:Individual
Prefix:DR
First Name:CLARA
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
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Mailing Address - Street 1:1 GUSTAVE L LEVY PL # 1230
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6504
Mailing Address - Country:US
Mailing Address - Phone:212-585-4631
Mailing Address - Fax:212-996-0987
Practice Address - Street 1:1425 MADISON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6514
Practice Address - Country:US
Practice Address - Phone:516-519-4631
Practice Address - Fax:212-996-0987
Is Sole Proprietor?:No
Enumeration Date:2014-07-24
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY020694103T00000X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist