Provider Demographics
NPI:1043536741
Name:INDIVIDUAL, MARRIAGE/DIVORCE AND FAMILY STUDIES, INC.
Entity Type:Organization
Organization Name:INDIVIDUAL, MARRIAGE/DIVORCE AND FAMILY STUDIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST PRESIDENT OF CORP.
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:KAHL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:516-867-8330
Mailing Address - Street 1:2748 RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-4917
Mailing Address - Country:US
Mailing Address - Phone:516-867-8330
Mailing Address - Fax:516-771-6455
Practice Address - Street 1:2748 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-4917
Practice Address - Country:US
Practice Address - Phone:516-867-8330
Practice Address - Fax:516-771-6455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty