Provider Demographics
NPI:1679677827
Name:LANDBERG, MICHELLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:LANDBERG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MICHELLE
Other - Middle Name:LANDBERG
Other - Last Name:BERNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:5 MUELLER MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:PUTNAM VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10579-3313
Mailing Address - Country:US
Mailing Address - Phone:845-528-1907
Mailing Address - Fax:845-528-1907
Practice Address - Street 1:5 MUELLER MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:PUTNAM VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10579-3313
Practice Address - Country:US
Practice Address - Phone:845-528-1907
Practice Address - Fax:845-528-1907
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007330-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist