Healthcare Provider Details

I. General information

NPI: 1306913603
Provider Name (Legal Business Name): UPPER MANHATTAN MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 08/22/2020
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: 212-694-3500
  • Fax: 212-694-4998
Mailing address:
  • Phone: 212-694-3500
  • Fax: 212-694-4998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

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