Healthcare Provider Details

I. General information

NPI: 1134441249
Provider Name (Legal Business Name): WASHINGTON SQUARE INSTITUTE FOR PSYCHOTHERAPY & MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2010
Last Update Date: 02/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41-51 EAST 11TH STREET, 4TH FL
NEW YORK NY
10003-4602
US

IV. Provider business mailing address

41-51 EAST 11TH STREET, 4TH FL
NEW YORK NY
10003-4602
US

V. Phone/Fax

Practice location:
  • Phone: 212-477-2600
  • Fax: 212-477-2040
Mailing address:
  • Phone: 212-477-2600
  • Fax: 212-477-2040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number#10699
License Number StateNY

VIII. Authorized Official

Name: GERD H FENCHEL
Title or Position: DIRECTOR/DEAN
Credential: PH.D. PSYCHOLOGIST
Phone: 212-477-2600