Provider Demographics
NPI:1699247361
Name:MCPHERSON, PRINCESS ANN
Entity type:Individual
Prefix:
First Name:PRINCESS
Middle Name:ANN
Last Name:MCPHERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 E FULTON ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-2102
Mailing Address - Country:US
Mailing Address - Phone:516-707-4289
Mailing Address - Fax:
Practice Address - Street 1:244 5TH AVE STE 2093
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-7604
Practice Address - Country:US
Practice Address - Phone:718-490-0761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008000101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health