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General NPI Number Information
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NPI Number | 1215752902
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE RELATIONAL PSYCHOTHERAPY LCSW, PLLC
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Dates
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Enumeration Date | 11/19/2024
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 325 BEAVER DAM RD
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City | BROOKHAVEN
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State | NY
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Zip | 11719-9673
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Country | US
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Telephone | 917-699-8802
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Fax |
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Provider Business Mailing Address
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Address Line | 41 W 83RD ST APT 7B
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City | NEW YORK
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State | NY
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Zip | 10024-5263
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Country | US
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Telephone | 917-699-8802
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Fax |
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Authorized Official
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Title or Position | MEMBER-MANAGER
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Name | ADAM STERN
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Credential | LCSW
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Telephone | 917-699-8802
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number |
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License Number State |
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