Provider Demographics
NPI:1750699633
Name:VU-NGUYEN, MARY (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:VU-NGUYEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:VU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:128 E 91ST ST STE A3
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-1648
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1745 BROADWAY
Practice Address - Street 2:17 FL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-4640
Practice Address - Country:US
Practice Address - Phone:212-851-8102
Practice Address - Fax:212-537-0102
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-14
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018778103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical