Provider Demographics
NPI:1033382601
Name:SENIOR CONNECTIONS PSYCHOLOGICAL SERVICES OF NEW YORK, PC
Entity Type:Organization
Organization Name:SENIOR CONNECTIONS PSYCHOLOGICAL SERVICES OF NEW YORK, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:832-448-2830
Mailing Address - Street 1:12012 WICKCHESTER LN
Mailing Address - Street 2:SUITE 550
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-1229
Mailing Address - Country:US
Mailing Address - Phone:832-448-2800
Mailing Address - Fax:832-448-2801
Practice Address - Street 1:256 SUNSET LAKE RD
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:NY
Practice Address - Zip Code:12754-2847
Practice Address - Country:US
Practice Address - Phone:832-448-2800
Practice Address - Fax:832-448-2801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-03
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02668179Medicaid
NYWET291Medicare PIN