Provider Demographics
NPI:1689722258
Name:NELSON, LIANE E (PHD)
Entity Type:Individual
Prefix:MS
First Name:LIANE
Middle Name:E
Last Name:NELSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:83 MIDDLEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-3008
Mailing Address - Country:US
Mailing Address - Phone:914-949-7699
Mailing Address - Fax:914-949-3224
Practice Address - Street 1:141 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530-1912
Practice Address - Country:US
Practice Address - Phone:914-949-7699
Practice Address - Fax:914-949-3224
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016458103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY367441OtherHEALTHNET
NYVM9631Medicare PIN