=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447374624
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PSYCHOLOGICAL SERVICES FOR MULTICULTURAL THERAPY, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/16/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19 WEST 34TH STREET SUITE 1200
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-947-7111
-----------------------------------------------------
Fax | 212-222-4594
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 392 CENTRAL PARK WEST SUITE 8D
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10025-5815
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-222-0349
-----------------------------------------------------
Fax | 212-222-4594
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. NANCY RUTH COPE
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 212-222-0349
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC1900X
-----------------------------------------------------
Taxonomy Name | Counseling Psychologist
-----------------------------------------------------
License Number | 010709
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------