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General NPI Number Information
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NPI Number | 1629200233
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Entity Type | Organization
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Legal Business Name | NEW YORK BEHAVIORAL HEALTH PSYCHOLOGICAL OFFICE, PLLC
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Dates
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Enumeration Date | 08/14/2009
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Last Update Date | 08/14/2009
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Provider Practice Location Address
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Address Line | 909 3RD AVE SUITE 505
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City | NEW YORK
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State | NY
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Zip | 10022-4731
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Country | US
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Telephone | 646-495-3078
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Fax |
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Provider Business Mailing Address
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Address Line | 909 3RD AVE SUITE 505
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City | NEW YORK
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State | NY
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Zip | 10022-4731
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Country | US
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Telephone | 646-495-3078
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | J FULLER
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Credential | PH.D.
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Telephone | 646-495-3078
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 017108
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License Number State | NY
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