Healthcare Provider Details

I. General information

NPI: 1972789931
Provider Name (Legal Business Name): DARREN BEDROSIAN LPSYA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2008
Last Update Date: 05/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 W 55TH ST 1B
NEW YORK NY
10019-4553
US

IV. Provider business mailing address

345 W 55TH ST 1B
NEW YORK NY
10019-4553
US

V. Phone/Fax

Practice location:
  • Phone: 646-504-6434
  • Fax:
Mailing address:
  • Phone: 646-504-6434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number0009000
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: