MEDICARE: CHILD AND FAMILY PSYCHIATRIC SERVICES

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	103TF0000X	Family Psychologist	213505	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	:	1396133278
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILD AND FAMILY PSYCHIATRIC SERVICES

Provider Business Mailing Address
First Line	:	347 VANDELINDA AVE
Second Line	:	PH
City	:	TEANECK
State	:	NJ
Zip	:	07666-3120
Country	:	US
Telephone Number	:	718-655-5552
Fax Number	:	201-357-4163

Provider Business Practice Location Address
First Line	:	3510 BAINBRIDGE AVE
Second Line	:	S1
City	:	BRONX
State	:	NY
Zip	:	10467-1409
Country	:	US
Telephone Number	:	718-655-5552
Fax Number	:	201-357-4163

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	ELSA TAPIA
Credential	:
Telephone Number	:	347-510-3638

Provider Enumeration Date	:	12/31/2014
Last Update Date	:	12/31/2014

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