MEDICARE: ST. VINCENT'S PSYCHIATRY ASSOCIATES

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	101YM0800X	Mental Health Counselor	700203TH	NY
2	283Q00000X	Psychiatric Hospital	700203TH	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134162886
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. VINCENT'S PSYCHIATRY ASSOCIATES

Provider Business Mailing Address
First Line	:	450 WEST 33RD STREET
Second Line	:	12TH FLOOR - ATTN: ROBERTO LUJAN
City	:	NEW YORK
State	:	NY
Zip	:	10001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	144 W 12TH ST
Second Line	:	REISS 1
City	:	NEW YORK
State	:	NY
Zip	:	10011-8202
Country	:	US
Telephone Number	:	212-604-8220
Fax Number	:	212-604-3778

Authorized Official
Title or Position	:	VICE PRESIDENT, PROGRAM DEVELOPMENT
Name	:	JOHN KASTAN
Credential	:	MD
Telephone Number	:	212-604-1571

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	09/11/2025

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