Provider Demographics
NPI:1548297997
Name:NEW YORK PSYCHOLOGICAL AND BEHAVIORAL SERVICES
Entity type:Organization
Organization Name:NEW YORK PSYCHOLOGICAL AND BEHAVIORAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:GIRARDIN
Authorized Official - Middle Name:
Authorized Official - Last Name:JEAN-LOUIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:718-951-0236
Mailing Address - Street 1:585 SCHENECTADY AVE
Mailing Address - Street 2:NYPBS/SLEEP
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203
Mailing Address - Country:US
Mailing Address - Phone:718-951-0236
Mailing Address - Fax:718-951-0238
Practice Address - Street 1:2306 NOSTRAND AVENUE
Practice Address - Street 2:BETWEEN AVE I AND J
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210
Practice Address - Country:US
Practice Address - Phone:718-951-0236
Practice Address - Fax:718-951-0238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015542103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02571108Medicaid
NYQ17050Medicare UPIN
NY02571108Medicaid