Healthcare Provider Details

I. General information

NPI: 1447707146
Provider Name (Legal Business Name): GARY M PROTTAS, LCSW PSYCHOANALYSIS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2016
Last Update Date: 11/12/2020
Certification Date: 11/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 WEST 20TH STREET ROOM 239
NEW YORK NY
10011-4313
US

IV. Provider business mailing address

20 WEST 20TH STREET ROOM 239
NEW YORK NY
10011-4313
US

V. Phone/Fax

Practice location:
  • Phone: 212-645-1152
  • Fax: 212-822-8505
Mailing address:
  • Phone: 212-645-1152
  • Fax: 212-822-8505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number078653
License Number StateNY

VIII. Authorized Official

Name: MR. GARY MICHAEL PROTTAS
Title or Position: SOLE PROPRIETOR
Credential: LCSW-R, LP
Phone: 212-645-1152