Healthcare Provider Details

I. General information

NPI: 1942448527
Provider Name (Legal Business Name): FIFTH AVENUE CENTER FOR COUNSELING AND PSYCHOTHERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2009
Last Update Date: 02/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 W 23RD ST 9TH FLOOR
NEW YORK NY
10010-5205
US

IV. Provider business mailing address

50 W 23RD ST 9TH FLOOR
NEW YORK NY
10010-5205
US

V. Phone/Fax

Practice location:
  • Phone: 212-989-0990
  • Fax: 212-792-6058
Mailing address:
  • Phone: 212-989-0990
  • Fax: 212-792-6058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JERRY M WEBER
Title or Position: EXECUTIVE DIRECTOR
Credential: LMHC
Phone: 212-989-2990