Provider Demographics
NPI:1841678588
Name:IVERS, NANCY (PHD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:
Last Name:IVERS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 BROADWAY
Mailing Address - Street 2:SUITE 22E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-6938
Mailing Address - Country:US
Mailing Address - Phone:212-724-0325
Mailing Address - Fax:
Practice Address - Street 1:1930 BROADWAY
Practice Address - Street 2:SUITE 22E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-6938
Practice Address - Country:US
Practice Address - Phone:212-724-0325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-14
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00324400103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling