Healthcare Provider Details

I. General information

NPI: 1568006260
Provider Name (Legal Business Name): RIVERDALE PSYCHOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2019
Last Update Date: 11/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3736 HENRY HUDSON PKWY STE 204
BRONX NY
10463-1514
US

IV. Provider business mailing address

3736 HENRY HUDSON PKWY STE 204
BRONX NY
10463-1514
US

V. Phone/Fax

Practice location:
  • Phone: 347-766-5771
  • Fax:
Mailing address:
  • Phone: 347-766-5771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. TAMAR BLANK
Title or Position: PRESIDENT
Credential: PSYD
Phone: 347-766-5771