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General NPI Number Information
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NPI Number | 1750678330
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Entity Type | Organization
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Legal Business Name | CENTRAL PARK WELLNESS CENTER LLC.
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Dates
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Enumeration Date | 07/05/2011
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Last Update Date | 10/28/2011
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Provider Practice Location Address
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Address Line | 1075 CENTRAL PARK AVE 307
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City | SCARSDALE
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State | NY
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Zip | 10583-3242
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Country | US
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Telephone | 914-874-5521
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Fax |
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Provider Business Mailing Address
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Address Line | 1075 CENTRAL PARK AVE 307
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City | SCARSDALE
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State | NY
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Zip | 10583-3242
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Country | US
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Telephone | 914-874-5521
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | CAROLYN STIMAN
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Credential | LCSW
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Telephone | 914-874-5521
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 076063-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 228923
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 228745
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License Number State | NY
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