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General NPI Number Information
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NPI Number | 1235570706
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Entity Type | Organization
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Legal Business Name | WEST SIDE PSYCHOTHERAPY, LCSW, P.C.
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Dates
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Enumeration Date | 07/12/2013
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Last Update Date | 07/12/2013
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Provider Practice Location Address
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Address Line | 350 CENTRAL PARK W SUITE 1A
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City | NEW YORK
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State | NY
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Zip | 10025-6547
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Country | US
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Telephone | 646-250-3182
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Fax |
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Provider Business Mailing Address
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Address Line | 201 W 94TH ST 3A
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City | NEW YORK
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State | NY
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Zip | 10025-6938
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Country | US
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Telephone | 646-350-3182
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT/THERAPIST
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Name | MR. MICHAEL ROGAN
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Credential | LMSW
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Telephone | 646-250-3182
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 054990-1
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License Number State | NY
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