Healthcare Provider Details

I. General information

NPI: 1467581843
Provider Name (Legal Business Name): EATING DISORDER RESOURCE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 W 58TH ST SUITE 206
NEW YORK NY
10019-1827
US

IV. Provider business mailing address

330 W 58TH ST SUITE 206
NEW YORK NY
10019-1827
US

V. Phone/Fax

Practice location:
  • Phone: 212-989-3987
  • Fax:
Mailing address:
  • Phone: 212-989-3987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. JUDITH BRISMAN
Title or Position: DIRECTOR
Credential: PH.D.
Phone: 212-989-3987