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General NPI Number Information
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NPI Number | 1184048589
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Entity Type | Organization
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Legal Business Name | WALL STREET PSYCHOLOGISTS PLLC
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Dates
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Enumeration Date | 02/06/2014
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Last Update Date | 02/06/2014
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Provider Practice Location Address
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Address Line | 82 WALL ST SUITE 1105
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City | NEW YORK
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State | NY
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Zip | 10005-3601
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Country | US
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Telephone | 212-509-2411
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Fax | 212-968-7962
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Provider Business Mailing Address
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Address Line | 82 WALL ST SUITE 1105
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City | NEW YORK
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State | NY
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Zip | 10005-3601
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Country | US
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Telephone | 212-509-2411
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Fax | 212-968-7962
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Authorized Official
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Title or Position | OWNER/CLINICAL PSYCHOLOGIST
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Name | DR. JOHN GRANGE GUINAN
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Credential | PH.D.
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Telephone | 212-509-2411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 004421
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License Number State | NY
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