Provider Demographics
NPI:1881872133
Name:PEARSON, DESIREE (PHD)
Entity type:Individual
Prefix:DR
First Name:DESIREE
Middle Name:
Last Name:PEARSON
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 1:226 W 26TH ST
Mailing Address - Street 2:FLOOR 8 OFFICE #25
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-6700
Mailing Address - Country:US
Mailing Address - Phone:917-745-3515
Mailing Address - Fax:
Practice Address - Street 1:226 W 26TH ST
Practice Address - Street 2:FLOOR 8 OFFICE #25
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-6700
Practice Address - Country:US
Practice Address - Phone:917-745-3515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-07
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY020586OtherLICENSE