Provider Demographics
NPI:1750507208
Name:DYE, THELMA DELORES (PHD)
Entity Type:Individual
Prefix:DR
First Name:THELMA
Middle Name:DELORES
Last Name:DYE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:THELMA
Other - Middle Name:DELORES
Other - Last Name:DYE-HOLMES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:175 W 87TH ST
Mailing Address - Street 2:17C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-2904
Mailing Address - Country:US
Mailing Address - Phone:212-426-3411
Mailing Address - Fax:
Practice Address - Street 1:1301 5TH AVE
Practice Address - Street 2:EXECUTIVE OFFICE NORTHSIDE CENTER FOR CHILD DEVELOP
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-3119
Practice Address - Country:US
Practice Address - Phone:212-426-3410
Practice Address - Fax:212-426-8919
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008554103T00000X, 103TC0700X, 103TC2200X, 103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily