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General NPI Number Information
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NPI Number | 1003184136
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Entity Type | Organization
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Legal Business Name | SUPPORTIVE PSYCHOLOGICAL SERVICES PC
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Dates
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Enumeration Date | 12/04/2011
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Last Update Date | 03/09/2015
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Provider Practice Location Address
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Address Line | 255 W 88TH ST APT 6B
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City | NEW YORK
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State | NY
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Zip | 10024-1717
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Country | US
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Telephone | 212-787-0874
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Fax | 866-411-9117
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Provider Business Mailing Address
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Address Line | 255 W 88TH ST APT 6B
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City | NEW YORK
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State | NY
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Zip | 10024-1717
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Country | US
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Telephone | 212-787-0874
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Fax | 866-411-9117
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RICHARD M BENNETT
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Credential | PHD
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Telephone | 212-787-0874
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State | NY
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