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General NPI Number Information
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NPI Number | 1588460885
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Entity Type | Organization
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Legal Business Name | RIVERBANK PSYCHOTHERAPY
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Dates
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Enumeration Date | 02/19/2025
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Last Update Date | 02/19/2025
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Provider Practice Location Address
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Address Line | 352 7TH AVE RM 1604
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City | NEW YORK
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State | NY
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Zip | 10001-5012
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Country | US
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Telephone | 917-683-1107
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Fax |
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Provider Business Mailing Address
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Address Line | 45 RIVER DR S APT 2514
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City | JERSEY CITY
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State | NJ
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Zip | 07310-3731
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Country | US
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Telephone | 917-683-1107
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | YIWEN FAN
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Credential |
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Telephone | 917-683-1107
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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