MEDICARE: NEW YORK PSYCHOLOGICAL AND BEHAVIORAL SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	015542	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548297997
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW YORK PSYCHOLOGICAL AND BEHAVIORAL SERVICES

Provider Business Mailing Address
First Line	:	585 SCHENECTADY AVE
Second Line	:	NYPBS/SLEEP
City	:	BROOKLYN
State	:	NY
Zip	:	11203
Country	:	US
Telephone Number	:	718-951-0236
Fax Number	:	718-951-0238

Provider Business Practice Location Address
First Line	:	2306 NOSTRAND AVENUE
Second Line	:	BETWEEN AVE I AND J
City	:	BROOKLYN
State	:	NY
Zip	:	11210
Country	:	US
Telephone Number	:	718-951-0236
Fax Number	:	718-951-0238

Authorized Official
Title or Position	:	PSYCHOLOGIST
Name	:	GIRARDIN JEAN-LOUIS
Credential	:	PH.D.
Telephone Number	:	718-951-0236

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	07/21/2022

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