Provider Demographics
NPI:1871868158
Name:VER HALEN, NISHA (PHD)
Entity Type:Individual
Prefix:DR
First Name:NISHA
Middle Name:
Last Name:VER HALEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:NISHA
Other - Middle Name:
Other - Last Name:BRADY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:149 PROSPECT PARK SW
Mailing Address - Street 2:#11
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-1236
Mailing Address - Country:US
Mailing Address - Phone:646-418-3691
Mailing Address - Fax:
Practice Address - Street 1:275 MADISON AVE
Practice Address - Street 2:SUITE 1916
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-1101
Practice Address - Country:US
Practice Address - Phone:646-418-3691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY68019355103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical