Healthcare Provider Details

I. General information

NPI: 1124221437
Provider Name (Legal Business Name): ADVANCED CENTER FOR PSYCHOTHERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2007
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

PO BOX 9161
UNIONDALE NY
11555-9161
US

V. Phone/Fax

Practice location:
  • Phone: 718-658-1123
  • Fax: 718-658-7091
Mailing address:
  • Phone: 631-391-7794
  • Fax: 631-454-4164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State

VIII. Authorized Official

Name: FRANK MESTECKS
Title or Position: ACCOUNTS MANAGER
Credential:
Phone: 718-206-6821