Provider Demographics
NPI:1710645510
Name:BANDER, KAREN WEISS (PHD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:WEISS
Last Name:BANDER
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:PO BOX 944
Mailing Address - Street 2:
Mailing Address - City:QUOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11959-0944
Mailing Address - Country:US
Mailing Address - Phone:914-649-2715
Mailing Address - Fax:
Practice Address - Street 1:303 5TH AVE RM 1107
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6668
Practice Address - Country:US
Practice Address - Phone:212-989-5480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005535103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY005535OtherNYS LICENSE