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General NPI Number Information
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NPI Number | 1083454219
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Entity Type | Organization
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Legal Business Name | PIVOT PSYCHOLOGY, PLLC
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Dates
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Enumeration Date | 05/27/2024
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Last Update Date | 05/27/2024
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Provider Practice Location Address
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Address Line | 303 5TH AVE
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City | NEW YORK
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State | NY
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Zip | 10016-6601
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Country | US
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Telephone | 347-292-8989
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Fax |
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Provider Business Mailing Address
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Address Line | 303 5TH AVE
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City | NEW YORK
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State | NY
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Zip | 10016-6601
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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 | FOUNDER, CLINICAL PSYCHOLOGIST
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Name | SAMANTHA LADELL
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Credential | PSYD
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Telephone | 347-292-8989
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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