=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336742691
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PELHAM CBT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/19/2020
-----------------------------------------------------
Last Update Date | 11/19/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 596 COLONIAL AVENUE
-----------------------------------------------------
City | PELHAM
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10803-2120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-315-9497
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 596 COLONIAL AVENUE
-----------------------------------------------------
City | PELHAM
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10803-2120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-315-9497
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHOLOGIST
-----------------------------------------------------
Name | DR. NICHOLAS R FORAND
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 917-548-4972
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------