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General NPI Number Information
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NPI Number | 1154538783
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Entity Type | Individual
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Provider Name | PHILIP BOCKMAN LCSW ACSW
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Gender | Male
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 01/29/2009
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Provider Practice Location Address
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Address Line | 817 BROADWAY 9TH FL., ROOM 2
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City | NEW YORK
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State | NY
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Zip | 10003
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Country | US
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Telephone | 917-868-7405
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Fax |
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Provider Business Mailing Address
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Address Line | 1613 GREEN ST APT C
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City | PHILADELPHIA
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State | PA
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Zip | 19130
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Country | US
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Telephone | 917-868-7405
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number | R0505141
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License Number State | NY
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