Provider Demographics
NPI:1962648378
Name:SASSON-GELMAN, EDIE JOY (PHD, CRC)
Entity Type:Individual
Prefix:DR
First Name:EDIE
Middle Name:JOY
Last Name:SASSON-GELMAN
Suffix:
Gender:F
Credentials:PHD, CRC
Other - Prefix:DR
Other - First Name:E. JOY
Other - Middle Name:
Other - Last Name:SASSON GELMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, CRC
Mailing Address - Street 1:954 LEXINGTON AVE # 287
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5055
Mailing Address - Country:US
Mailing Address - Phone:917-830-4456
Mailing Address - Fax:888-972-3492
Practice Address - Street 1:41 CENTRAL PARK W APT 1H
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-6732
Practice Address - Country:US
Practice Address - Phone:917-830-4456
Practice Address - Fax:888-972-3492
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-07
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY25477103TR0400X
NY021599103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY021599OtherPSYCHOLOGIST LICENSE