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General NPI Number Information
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NPI Number | 1659627206
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Entity Type | Organization
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Legal Business Name | SURBAUGH PSYCHOLOGICAL SERVICES LLC
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Dates
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Enumeration Date | 08/01/2012
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Last Update Date | 11/07/2012
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Provider Practice Location Address
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Address Line | 31 WASHINGTON SQ W SUITE 5R
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City | NEW YORK
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State | NY
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Zip | 10011-9126
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Country | US
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Telephone | 917-974-6733
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Fax |
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Provider Business Mailing Address
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Address Line | 31 WASHINGTON SQ W SUITE 5R
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City | NEW YORK
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State | NY
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Zip | 10011-9126
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Country | US
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Telephone | 917-974-6733
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST AND OWNER
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Name | JULIE SURBAUGH
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Credential | PSY.D.
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Telephone | 917-974-6733
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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 | 017851
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License Number State | NY
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