Provider Demographics
NPI:1174556443
Name:LE BOW, MICHELLE MANUALA (PSYD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:MANUALA
Last Name:LE BOW
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 W 77TH ST
Mailing Address - Street 2:APT #7F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-5128
Mailing Address - Country:US
Mailing Address - Phone:212-724-8767
Mailing Address - Fax:
Practice Address - Street 1:20 W 72ND ST
Practice Address - Street 2:SUITE 1103
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-4100
Practice Address - Country:US
Practice Address - Phone:212-724-8767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000534-1103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis