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General NPI Number Information
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NPI Number | 1467581843
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Entity Type | Organization
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Legal Business Name | EATING DISORDER RESOURCE CENTER
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Dates
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Enumeration Date | 03/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 330 W 58TH ST SUITE 206
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City | NEW YORK
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State | NY
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Zip | 10019-1827
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Country | US
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Telephone | 212-989-3987
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Fax |
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Provider Business Mailing Address
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Address Line | 330 W 58TH ST SUITE 206
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City | NEW YORK
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State | NY
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Zip | 10019-1827
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Country | US
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Telephone | 212-989-3987
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. JUDITH BRISMAN
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Credential | PH.D.
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Telephone | 212-989-3987
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number |
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License Number State |
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