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General NPI Number Information
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NPI Number | 1013623925
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Entity Type | Organization
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Legal Business Name | RIVERGREEN PSYCHOLOGY PSYCHOTHERAPY PC
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Dates
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Enumeration Date | 01/24/2023
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Last Update Date | 01/24/2023
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Provider Practice Location Address
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Address Line | 75 MAIDEN LN STE 323
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City | NEW YORK
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State | NY
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Zip | 10038-4810
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Country | US
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Telephone | 212-379-6447
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Fax |
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Provider Business Mailing Address
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Address Line | 8 N FRONT ST
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City | KINGSTON
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State | NY
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Zip | 12401-3814
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CLARK MATTHEW NICHOLS
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Credential | PHD
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Telephone | 212-379-6447
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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