=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962761148
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PSYCHOANALYTIC TRAINING INSTITUTE OF THE CONTEMPORARY FREUDIAN SOCIETY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2012
-----------------------------------------------------
Last Update Date | 07/09/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 40 W 13TH ST
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10011-7940
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-752-7883
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1173A 2ND AVE #323
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10065-8277
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-752-7883
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATIVE DIRECTOR
-----------------------------------------------------
Name | MRS. CONNIE STROBOULIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 732-446-4867
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------