Healthcare Provider Details

I. General information

NPI: 1275695371
Provider Name (Legal Business Name): METROPOLITAN CENTER FOR MENTAL HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 02/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 W 86TH ST
NEW YORK NY
10024-4018
US

IV. Provider business mailing address

160 W 86TH ST
NEW YORK NY
10024-4018
US

V. Phone/Fax

Practice location:
  • Phone: 212-362-8755
  • Fax: 212-362-9451
Mailing address:
  • Phone: 212-362-8755
  • Fax: 212-362-9451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number6722100A
License Number StateNY

VIII. Authorized Official

Name: DR. ROBERT BASILE
Title or Position: EXECUTIVE DIRECTOR
Credential: PSY.D.
Phone: 212-362-8755