=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477933695
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AHRC NYC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2015
-----------------------------------------------------
Last Update Date | 06/03/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 HILLSIDE AVE APT 4A
-----------------------------------------------------
City | GREAT NECK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11021-3229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-297-6645
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 HILLSIDE AVE APT 4A
-----------------------------------------------------
City | GREAT NECK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11021-3229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-297-6645
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHOLOGIST
-----------------------------------------------------
Name | DR. JONATHAN SCOTT KENT
-----------------------------------------------------
Credential | PSY.D.
-----------------------------------------------------
Telephone | 515-297-6645
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------