Provider Demographics
NPI:1205114113
Name:ALDERMAN, PHILIP (MSED)
Entity type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:
Last Name:ALDERMAN
Suffix:
Gender:M
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 N BROADWAY
Mailing Address - Street 2:APT. 72W
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1233
Mailing Address - Country:US
Mailing Address - Phone:914-969-5490
Mailing Address - Fax:
Practice Address - Street 1:912 N BROADWAY
Practice Address - Street 2:APT. 72W
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1233
Practice Address - Country:US
Practice Address - Phone:914-969-5490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-26
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1165306103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool