Provider Demographics
NPI:1073897906
Name:CHARLES BERSHATSKY, PHD, LCSW, PC
Entity Type:Organization
Organization Name:CHARLES BERSHATSKY, PHD, LCSW, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:BERSHATSKY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCSW
Authorized Official - Phone:212-496-8989
Mailing Address - Street 1:239 CENTRAL PARK W
Mailing Address - Street 2:1AS
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-6038
Mailing Address - Country:US
Mailing Address - Phone:212-496-8989
Mailing Address - Fax:
Practice Address - Street 1:239 CENTRAL PARK W
Practice Address - Street 2:1AS
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-6038
Practice Address - Country:US
Practice Address - Phone:212-496-8989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR029741-1261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)