Provider Demographics
NPI:1316146707
Name:NIMROODY, TEHELA (PHD)
Entity type:Individual
Prefix:
First Name:TEHELA
Middle Name:
Last Name:NIMROODY
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 1:250 E 65TH ST
Mailing Address - Street 2:11G
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-6616
Mailing Address - Country:US
Mailing Address - Phone:212-721-2547
Mailing Address - Fax:212-721-2547
Practice Address - Street 1:250 E 65TH ST
Practice Address - Street 2:11G
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6616
Practice Address - Country:US
Practice Address - Phone:212-721-2547
Practice Address - Fax:212-721-2547
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018775103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical