Mansour (Max) Banilivy, PH.D.
Individual provider Active NPI Clinical Psychologist · Merrick, NY
NPI 1023026754 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1023026754
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 007526 (NY)
- Practice address
- 2615 Merrick Ave
Merrick, NY 11566-4622 - Phone
- (516) 627-9432
- Fax
- (516) 867-0013
- NPI assigned
- Aug 5, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 007526 | NY | MD | Mental Health Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 007526 | NY | Yes |
Addresses
Primary practice location
2615 Merrick Ave
Merrick, NY 11566-4622
Mailing address
2615 Merrick Ave
Merrick, NY 11566-4622
Phone (516) 627-9432
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00795840 | Medicaid | NY |
Other providers in Merrick, NY
- Edgardo A Bacalan Jr.
- Kelly M Baccari
- Galia Bagdasarov
- Barbara Ann Bailey
- Nicole Ballas
- Pamela Banks
- Barbara a Feingold, PHD
- Barbara Ann Feingold PHD Psychologist PC
- Jacqueline Mia Barkan Clarke
- Adi Baron
All providers in Merrick, NY · Clinical Psychologist in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.