Provider Demographics
NPI:1902235914
Name:BRONX INDIVIDUAL & FAMILY PSYCHOLOGY LLC
Entity Type:Organization
Organization Name:BRONX INDIVIDUAL & FAMILY PSYCHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER (PSYCHOLOGIST)
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:LYDIA
Authorized Official - Last Name:VAYAS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:917-801-1199
Mailing Address - Street 1:22 E KINGSBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-7596
Mailing Address - Country:US
Mailing Address - Phone:917-801-1199
Mailing Address - Fax:917-801-1198
Practice Address - Street 1:22 E KINGSBRIDGE RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-7596
Practice Address - Country:US
Practice Address - Phone:917-801-1199
Practice Address - Fax:917-801-1198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-11
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY102065103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty