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General NPI Number Information
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NPI Number | 1801377577
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Entity Type | Organization
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Legal Business Name | TAPESTRY PSYCHOTHERAPY LCSW PLLC
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Dates
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Enumeration Date | 08/22/2018
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Last Update Date | 08/22/2018
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Provider Practice Location Address
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Address Line | 853 BROADWAY STE 2001
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City | NEW YORK
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State | NY
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Zip | 10003-4705
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Country | US
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Telephone | 917-733-2899
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Fax |
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Provider Business Mailing Address
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Address Line | 853 BROADWAY STE 2001
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City | NEW YORK
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State | NY
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Zip | 10003-4705
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Country | US
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Telephone | 917-733-2899
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. KRISTIN ELIZABETH WYNN
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Credential | LCSW
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Telephone | 917-733-2899
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 083839-1
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License Number State | NY
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