Provider Demographics
NPI:1790088946
Name:SOMMER, TAL
Entity Type:Individual
Prefix:DR
First Name:TAL
Middle Name:
Last Name:SOMMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 70 QUEENS BOULEVARD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-3694
Mailing Address - Country:US
Mailing Address - Phone:718-275-6010
Mailing Address - Fax:718-275-6062
Practice Address - Street 1:104 70 QUEENS BOULEVARD
Practice Address - Street 2:SUITE 200
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-3694
Practice Address - Country:US
Practice Address - Phone:718-275-6010
Practice Address - Fax:718-275-6062
Is Sole Proprietor?:No
Enumeration Date:2010-12-09
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022502-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical