Provider Demographics
NPI:1144373291
Name:TORTORELLA, WILLIAM M (PHD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:M
Last Name:TORTORELLA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 E 86TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-4714
Mailing Address - Country:US
Mailing Address - Phone:212-369-3161
Mailing Address - Fax:212-369-3161
Practice Address - Street 1:315 E 86TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-4714
Practice Address - Country:US
Practice Address - Phone:212-369-3161
Practice Address - Fax:212-369-3161
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003339103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02144750Medicaid
NY02144750Medicaid