Provider Demographics
NPI:1669455416
Name:HEGEMAN, ELIZABETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:HEGEMAN
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 1:100 RIVERSIDE DR
Mailing Address - Street 2:10C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-4822
Mailing Address - Country:US
Mailing Address - Phone:212-874-5610
Mailing Address - Fax:
Practice Address - Street 1:490 W END AVE
Practice Address - Street 2:SUITE LE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-4329
Practice Address - Country:US
Practice Address - Phone:212-877-3007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-25
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004431103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV68801Medicare ID - Type UnspecifiedCLINICAL PSYCHOLOGIST