Provider Demographics
NPI:1861995201
Name:PSYCHOLOGICAL WELLNESS OF NEW YORK, P.C.
Entity type:Organization
Organization Name:PSYCHOLOGICAL WELLNESS OF NEW YORK, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTA
Authorized Official - Middle Name:TERESA
Authorized Official - Last Name:SILVA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:516-241-0458
Mailing Address - Street 1:16 LEEWARD CV
Mailing Address - Street 2:
Mailing Address - City:BAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11709-1018
Mailing Address - Country:US
Mailing Address - Phone:516-241-0458
Mailing Address - Fax:
Practice Address - Street 1:2100 DEER PARK AVE STE 7
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-2119
Practice Address - Country:US
Practice Address - Phone:800-528-0135
Practice Address - Fax:800-528-0135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017045103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty