Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Dr. John L. Theodore, PHD

Individual provider Clinical Psychologist · NPI 1639396641

Dr. John L. Theodore, PHD is a Clinical Psychologist in New York, New York. Practices as a sole proprietor. Licensed in New York.

Licensed in
NY
In the registry since
2007
What do these letters mean?
PHD — Doctor of Philosophy
A research doctorate. In healthcare it usually sits alongside a clinical licence.

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Practice location Address checks out

412 Avenue Of The Americas Ste 413
New York, NY 10011-8409 Not confirmed with CMS for 15 years — call before visiting
Phone: (646) 239-7774
Fax: (212) 388-1215
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Psychologist (primary) Taxonomy 103TC0700X · Licence 68 017120 (NY)

Record details

NPI number1639396641
Entity typeIndividual (Type 1)
GenderMale
Credentials PHD
Sole proprietorYes
NPI enumeratedApril 19, 2007
Last updated in NPPESDecember 21, 2010

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