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General NPI Number Information
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NPI Number | 1972884153
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Entity Type | Organization
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Legal Business Name | DOUGLAS PSYCHOTHERAPY SERVICES, LCSW, PC
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Dates
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Enumeration Date | 09/01/2011
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Last Update Date | 11/04/2016
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Provider Practice Location Address
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Address Line | 1199 PARK AVE SUITE 1C
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City | NEW YORK
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State | NY
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Zip | 10128
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Country | US
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Telephone | 212-828-7473
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Fax |
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Provider Business Mailing Address
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Address Line | 1199 PARK AVE SUITE 1C
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City | NEW YORK
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State | NY
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Zip | 10128
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Country | US
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Telephone | 212-828-7473
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | PETER-ALEXANDER D DOUGLAS
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Credential | LCSW-R
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Telephone | 212-828-7473
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | PR060963-1
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License Number State | NY
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