Healthcare Provider Details

I. General information

NPI: 1407233786
Provider Name (Legal Business Name): EKM PSYCHOLOGICAL COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2015
Last Update Date: 05/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 W 71ST ST APT 1C
NEW YORK NY
10023-4021
US

IV. Provider business mailing address

79 COOPER LN
LARCHMONT NY
10538-1802
US

V. Phone/Fax

Practice location:
  • Phone: 917-602-2186
  • Fax:
Mailing address:
  • Phone: 917-602-2186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number018533
License Number StateNY

VIII. Authorized Official

Name: ERICA MACGREGOR
Title or Position: PSYCHOLOGIST
Credential: PHD
Phone: 917-602-2186