Provider Demographics
NPI:1609544220
Name:PERSONALIZED PSYCHOLOGY PLLC
Entity Type:Organization
Organization Name:PERSONALIZED PSYCHOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSES
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:347-645-2445
Mailing Address - Street 1:933 MAMARONECK AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-1661
Mailing Address - Country:US
Mailing Address - Phone:347-645-2445
Mailing Address - Fax:
Practice Address - Street 1:933 MAMARONECK AVE STE 202
Practice Address - Street 2:
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-1661
Practice Address - Country:US
Practice Address - Phone:347-645-2445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty