MEDICARE: CENTER FOR COGNITIVE AND DIALECTICAL BEHAVIOR THERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker
2	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1013131465
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR COGNITIVE AND DIALECTICAL BEHAVIOR THERAPY

Provider Business Mailing Address
First Line	:	2001 MARCUS AVE
Second Line	:	SUITE E128
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11042-1011
Country	:	US
Telephone Number	:	516-390-3525
Fax Number	:	516-396-2195

Provider Business Practice Location Address
First Line	:	1981 MARCUS AVE
Second Line	:	SUITE C119
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11042-1038
Country	:	US
Telephone Number	:	516-390-3525
Fax Number	:	516-396-2195

Authorized Official
Title or Position	:	PSYCHOLOGIST
Name	:	DR. ADAM PAYNE
Credential	:	PH.D.
Telephone Number	:	516-390-3525

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	06/03/2010

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