MEDICARE: CENTER FOR PSYCHOLOGICAL WELL-BEING

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
2	104100000X	Social Worker
3	103T00000X	Psychologist	018339	NY

General Provider Information

NPI Number	:	1528308632
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR PSYCHOLOGICAL WELL-BEING

Provider Business Mailing Address
First Line	:	330 W 58TH ST
Second Line	:	SUITE 310
City	:	NEW YORK
State	:	NY
Zip	:	10019-1821
Country	:	US
Telephone Number	:	212-464-7796
Fax Number	:

Provider Business Practice Location Address
First Line	:	330 W 58TH ST
Second Line	:	SUITE 310
City	:	NEW YORK
State	:	NY
Zip	:	10019-1821
Country	:	US
Telephone Number	:	212-464-7796
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	REUBEN ROBBINS
Credential	:	PH.D.
Telephone Number	:	212-464-7796

Provider Enumeration Date	:	02/26/2013
Last Update Date	:	02/26/2013

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