Healthcare Provider Details

I. General information

NPI: 1477585206
Provider Name (Legal Business Name): ADVANCED CENTER FOR PSYCHOTHERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

178-10 WEXFORD TERRACE
JAMAICA ESTATES NY
11432
US

IV. Provider business mailing address

178-10 WEXFORD TERRACE
JAMAICA ESTATES NY
11432
US

V. Phone/Fax

Practice location:
  • Phone: 718-739-7099
  • Fax: 718-658-4641
Mailing address:
  • Phone: 718-739-7099
  • Fax: 718-658-4641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: FRANK MESTECKY
Title or Position: ACCOUNTANT
Credential: MBA
Phone: 718-206-6821