Healthcare Provider Details

I. General information

NPI: 1033864160
Provider Name (Legal Business Name): SANCTUARY PSYCHOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2022
Last Update Date: 02/17/2022
Certification Date: 02/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 W 57TH ST STE 1101
NEW YORK NY
10019-2814
US

IV. Provider business mailing address

57 W 57TH ST STE 1101
NEW YORK NY
10019-2814
US

V. Phone/Fax

Practice location:
  • Phone: 800-381-7340
  • Fax:
Mailing address:
  • Phone: 800-381-7340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: GRETA GLEISSNER
Title or Position: FOUNDER
Credential: LCSW
Phone: 917-373-4557