Healthcare Provider Details

I. General information

NPI: 1790229706
Provider Name (Legal Business Name): PETER GEVISSER LMFT/MCP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

275 7TH AVE SUITE 2501
NEW YORK NY
10001-6708
US

IV. Provider business mailing address

275 7TH AVE SUITE 2501
NEW YORK NY
10001-6708
US

V. Phone/Fax

Practice location:
  • Phone: 347-387-4024
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number001102
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: