Provider Demographics
NPI:1902811342
Name:NEW YORK PSYCHOTHERAPY AND COUNSELING CENTER
Entity Type:Organization
Organization Name:NEW YORK PSYCHOTHERAPY AND COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ELLIOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-553-1100
Mailing Address - Street 1:17620 148TH AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-5518
Mailing Address - Country:US
Mailing Address - Phone:718-553-1100
Mailing Address - Fax:718-553-6769
Practice Address - Street 1:17620 148TH AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-5518
Practice Address - Country:US
Practice Address - Phone:718-553-1100
Practice Address - Fax:718-553-6769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00245056Medicaid
NY00245056Medicaid
NYWZVRV1Medicare UPIN