Healthcare Provider Details

I. General information

NPI: 1053335620
Provider Name (Legal Business Name): UPPER MANHATTAN MENTAL HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 10/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1727 AMSTERDAM AVE
NEW YORK NY
10031-4611
US

IV. Provider business mailing address

1727 AMSTERDAM AVE
NEW YORK NY
10031-4611
US

V. Phone/Fax

Practice location:
  • Phone: 212-694-9200
  • Fax: 212-368-5608
Mailing address:
  • Phone: 212-694-9200
  • Fax: 212-368-5608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM WITHERSPOON
Title or Position: EXECUTIVE DIRECTOR
Credential: LCSW
Phone: 212-694-9200