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General NPI Number Information
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NPI Number | 1851532196
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Entity Type | Organization
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Legal Business Name | RIVERTOWNS PSYCHOLOGICAL ASSOCIATES, P.C.
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Dates
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Enumeration Date | 03/17/2009
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Last Update Date | 03/17/2009
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Provider Practice Location Address
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Address Line | 875 W END AVE SUITE 1B
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City | NEW YORK
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State | NY
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Zip | 10025-4919
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Country | US
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Telephone | 914-400-3588
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Fax | 914-478-5192
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Provider Business Mailing Address
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Address Line | 545 SAW MILL RIVER RD SUITE 3C-S1
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City | ARDSLEY
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State | NY
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Zip | 10502-2157
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Country | US
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Telephone | 914-329-0759
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Fax | 914-478-5192
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEFFERY TAYLOR DYKE
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Credential | PH.D.
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Telephone | 914-400-3588
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 013148-1
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License Number State | NY
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