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General NPI Number Information
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NPI Number | 1609038900
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Entity Type | Organization
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Legal Business Name | JEFFREY KASSINOVE, PSYCHOLOGIST
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Dates
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Enumeration Date | 06/27/2008
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Last Update Date | 07/18/2024
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Provider Practice Location Address
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Address Line | 175 W 79TH ST SUITE 1A
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City | NEW YORK
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State | NY
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Zip | 10024-6450
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Country | US
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Telephone | 212-580-0080
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Fax |
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Provider Business Mailing Address
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Address Line | 37 W 65TH ST FL 5
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City | NEW YORK
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State | NY
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Zip | 10023-6610
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. JEFFREY KASSINOVE
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Credential |
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Telephone | 212-580-0080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 014602
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License Number State | NY
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