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General NPI Number Information
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NPI Number | 1861995201
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Entity Type | Organization
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Legal Business Name | PSYCHOLOGICAL WELLNESS OF NEW YORK, P.C.
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Dates
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Enumeration Date | 03/12/2018
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 2100 DEER PARK AVE STE 7
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City | DEER PARK
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State | NY
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Zip | 11729-2119
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Country | US
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Telephone | 800-528-0135
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Fax | 800-528-0135
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Provider Business Mailing Address
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Address Line | 16 LEEWARD CV
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City | BAYVILLE
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State | NY
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Zip | 11709-1018
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Country | US
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Telephone | 516-241-0458
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Fax |
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Authorized Official
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Title or Position | OWNER/PSYCHOLOGIST
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Name | DR. MARTA TERESA SILVA
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Credential | PSY.D.
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Telephone | 516-241-0458
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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 | 017045
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License Number State | NY
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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 | 017045
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License Number State | NY
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