Healthcare Provider Details

I. General information

NPI: 1013131465
Provider Name (Legal Business Name): CENTER FOR COGNITIVE AND DIALECTICAL BEHAVIOR THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 06/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1981 MARCUS AVE SUITE C119
NEW HYDE PARK NY
11042-1038
US

IV. Provider business mailing address

2001 MARCUS AVE SUITE E128
NEW HYDE PARK NY
11042-1011
US

V. Phone/Fax

Practice location:
  • Phone: 516-390-3525
  • Fax: 516-396-2195
Mailing address:
  • Phone: 516-390-3525
  • Fax: 516-396-2195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. ADAM PAYNE
Title or Position: PSYCHOLOGIST
Credential: PH.D.
Phone: 516-390-3525