Healthcare Provider Details

I. General information

NPI: 1548266638
Provider Name (Legal Business Name): THE IN-HOME PSYCHOTHERAPY SERVICE OF GREATER NY, LCSW, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 08/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3706 BERNE RD
WANTAGH NY
11793-3114
US

IV. Provider business mailing address

3706 BERNE RD
WANTAGH NY
11793-3114
US

V. Phone/Fax

Practice location:
  • Phone: 516-785-6433
  • Fax:
Mailing address:
  • Phone: 516-785-6433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR025860-1
License Number StateNY

VIII. Authorized Official

Name: MR. DAVID BINDER
Title or Position: PRESIDENT
Credential: LCSW
Phone: 516-785-6433