Healthcare Provider Details

I. General information

NPI: 1437329489
Provider Name (Legal Business Name): RMG MARRIAGE AND FAMILY THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2008
Last Update Date: 11/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 W 9TH ST SUITE 3A
NEW YORK NY
10011-8971
US

IV. Provider business mailing address

26 W 9TH ST SUITE 3A
NEW YORK NY
10011-8971
US

V. Phone/Fax

Practice location:
  • Phone: 212-534-9959
  • Fax: 202-255-0754
Mailing address:
  • Phone: 212-534-9959
  • Fax: 202-255-0754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number000391
License Number StateNY

VIII. Authorized Official

Name: RICHARD MARK GLIDDEN
Title or Position: PRESIDENT
Credential: LMFT
Phone: 212-534-9959