Healthcare Provider Details

I. General information

NPI: 1790629681
Provider Name (Legal Business Name): NORTHERN WESTCHESTER PSYCHOANALYSIS MARRIAGE AND FAMILY THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 SMITH RIDGE RD
SOUTH SALEM NY
10590-1921
US

IV. Provider business mailing address

122 SMITH RIDGE RD
SOUTH SALEM NY
10590-1921
US

V. Phone/Fax

Practice location:
  • Phone: 646-469-5000
  • Fax:
Mailing address:
  • Phone: 646-469-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. ANDI LYN KORNFELD
Title or Position: OWNER
Credential: LMFT
Phone: 646-469-5000