=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457788465
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTER FOR PSYCHOLOGICAL AND INTERPERSONAL DEVELOPMENT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2013
-----------------------------------------------------
Last Update Date | 10/04/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 352 7TH AVE SUITE 1005
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10001-5012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-200-5088
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 352 7TH AVE SUITE 1005
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10001-5012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-200-5088
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | ZOYA SIMAKHODSKAYA
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 646-200-5088
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | NYS-015675
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------