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General NPI Number Information
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NPI Number | 1841094687
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Entity Type | Organization
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Legal Business Name | PARK CENTRAL PSYCHOLOGY, PLLC
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Dates
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Enumeration Date | 04/02/2025
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Last Update Date | 04/02/2025
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Provider Practice Location Address
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Address Line | 7 CLIFF WAY
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City | LARCHMONT
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State | NY
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Zip | 10538-2505
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Country | US
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Telephone | 914-539-7661
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Fax |
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Provider Business Mailing Address
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Address Line | 7 CLIFF WAY
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City | LARCHMONT
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State | NY
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Zip | 10538-2505
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Country | US
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Telephone | 914-473-9615
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. JEROME H KOGAN
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Credential | PSYD
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Telephone | 914-473-9615
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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