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General NPI Number Information
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NPI Number | 1568006260
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Entity Type | Organization
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Legal Business Name | RIVERDALE PSYCHOLOGY LLC
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Dates
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Enumeration Date | 11/05/2019
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Last Update Date | 11/05/2019
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Provider Practice Location Address
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Address Line | 3736 HENRY HUDSON PKWY STE 204
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City | BRONX
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State | NY
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Zip | 10463-1514
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Country | US
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Telephone | 347-766-5771
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Fax |
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Provider Business Mailing Address
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Address Line | 3736 HENRY HUDSON PKWY STE 204
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City | BRONX
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State | NY
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Zip | 10463-1514
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Country | US
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Telephone | 347-766-5771
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TAMAR BLANK
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Credential | PSYD
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Telephone | 347-766-5771
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TF0000X
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Taxonomy Name | Family Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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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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Taxonomy #5
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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