Honorific== select == Mr. Ms. Miss Mrs. Dr.
First Name
Middle Name/Initial
Last Name
Degree(s)
Title/Position
Organization
Address
City
State== select == ==USA== AK AL AR AS AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MI MN MO MR MS MT NC ND NE NH NJ NM NN NV NY OH OK OR PA PL PO PR RI SC SD TN TT TX UT VA VI VT WA WI WV WY ==Canada== AB BC MB NB NL NS NT NU ON PE QC SK YT ==Outside US and Canada== OTHER
Zip Code
Country== select == Canada United States --- Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegowina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, the Democratic Republic of the Cook Islands Costa Rica Cote d'Ivoire Croatia (Hrvatska) Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France France, Metropolitan French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard and Mc Donald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, Democratic People's Republic of Korea, Republic of Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macau Macedonia, The Former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Moldova, Republic of Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Seychelles Sierra Leone Singapore Slovakia (Slovak Republic) Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands Spain Sri Lanka St. Helena St. Pierre and Miquelon Sudan Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania, United Republic of Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela Viet Nam Virgin Islands (British) Virgin Islands (U.S.) Wallis and Futuna Islands Western Sahara Yemen Yugoslavia Zambia Zimbabwe
Phone
E-mail
Birthdate(month) Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec ,
Partner
Website
Undergraduate Diploma
Graduate School/Medical School
Year of Graduation
Anticipated Graduation
Clinical Internship/Residency Program
Other Training Experience
Bio/Background
Twitter (Please insert URL)
Facebook (Please insert URL)
LinkedIn (Please insert URL)
Areas of Practice (check up to 7) Addictions/Substance ADHD Adoption Aging, Death and Dying Anger Management Anxiety Disorders Attachment Disorders Autism Spectrum Disorder Bipolar Disorder Borderline Personality Bullying Codependency Creative Blocks Depression and Mood Disorders Developmental Disorders Diversities Divorce Eating Disorders Family Conflict Gender Identity Grief and Loss Infertility, Pregnancy, Prenatal, and Postpartum Intimacy and Sexuality LGBTQQ Life Transitions/Adjustments Medication Management Narcissistic Personality Obsessive-Compulsive Disorder Pain Management and Chronic Illness Parenting Peer Relationships Psychotic Disorders Relationship Issues School Issues Spirituality Suicidality and Self-Harm Transgender Trauma and PTSD Work/Career Issues
Years in practice== select == 1-5 6-10 11-20 20 or more
License Type MD Psychiatrist Psychologist Research Psychoanalyst Student Research Psychoanalyst LCSW LMFT LPCC PreLic Retired None Other
Other License Type
License #
License Exp.
License Upload (4MB maximum file upload size)
Malpractice Insurance #
Malpractice Insurance Exp.
Malpractice Information (4MB maximum file upload size)
Languages
Populations Served Infants Children Adolescents Children and Adolescents Adults Older Adults Couples Families Groups Testing/Evaluation/Assessment
Sliding Scale Y N
I am currently accepting new patients Y N
List profile in member directories? visible hidden
Who can view your profile? public members only administrators only
Do you consent to receive email communications from us? Y N
Do you want to display your email on your profile? Y N
I would like to receive emails on Continuing Education Programs (including Film and Mind) General Information and Special Events 2-year Psychoanalytic Psychotherapy Psychoanalytic Training
