Provider Demographics
NPI:1083328520
Name:PARK AVENUE PSYCHOTHERAPY LCSW PC
Entity Type:Organization
Organization Name:PARK AVENUE PSYCHOTHERAPY LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:HADDON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:917-334-6069
Mailing Address - Street 1:100 PARK AVE FL 16
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-5538
Mailing Address - Country:US
Mailing Address - Phone:917-334-6069
Mailing Address - Fax:
Practice Address - Street 1:221 RIVER ST STE 9
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-5990
Practice Address - Country:US
Practice Address - Phone:917-334-6069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PARK AVENUE PSYCHOTHERAPY LCSW PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-01-10
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty