Provider Demographics
NPI:1063043727
Name:CONDON PSYCHOLOGICAL SERVICES PLLC
Entity Type:Organization
Organization Name:CONDON PSYCHOLOGICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:CONDON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:917-626-0482
Mailing Address - Street 1:928 BROADWAY STE 1105
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-8111
Mailing Address - Country:US
Mailing Address - Phone:917-626-0482
Mailing Address - Fax:
Practice Address - Street 1:928 BROADWAY STE 1105
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-8111
Practice Address - Country:US
Practice Address - Phone:917-626-0482
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-31
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty