Healthcare Provider Details

I. General information

NPI: 1841094687
Provider Name (Legal Business Name): PARK CENTRAL PSYCHOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2025
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 CLIFF WAY
LARCHMONT NY
10538-2505
US

IV. Provider business mailing address

7 CLIFF WAY
LARCHMONT NY
10538-2505
US

V. Phone/Fax

Practice location:
  • Phone: 914-539-7661
  • Fax:
Mailing address:
  • Phone: 914-473-9615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. JEROME H KOGAN
Title or Position: MANAGER
Credential: PSYD
Phone: 914-473-9615