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General NPI Number Information
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NPI Number | 1306135611
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Entity Type | Organization
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Legal Business Name | NEW VISION THERAPY
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Dates
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Enumeration Date | 04/07/2011
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Last Update Date | 04/07/2011
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Provider Practice Location Address
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Address Line | 80 E 11TH ST SUITE 528
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City | NEW YORK
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State | NY
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Zip | 10003-6811
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Country | US
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Telephone | 917-880-6540
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Fax |
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Provider Business Mailing Address
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Address Line | 80 E 11TH ST SUITE 528
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City | NEW YORK
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State | NY
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Zip | 10003-6811
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Country | US
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Telephone | 917-880-6540
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPY
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Name | JOSE LUIS GUERRA
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Credential | MA, LMHC
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Telephone | 917-880-6540
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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