Provider Demographics
NPI:1093269268
Name:ISSA & WEINGEROFF PSYCHOLOGY ASSOCIATES PLLC
Entity Type:Organization
Organization Name:ISSA & WEINGEROFF PSYCHOLOGY ASSOCIATES PLLC
Other - Org Name:CENTER FOR DYNAMIC AND BEHAVIORAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-FOUNDER, PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ISSA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:212-653-8894
Mailing Address - Street 1:330 W 58TH ST STE 502
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1819
Mailing Address - Country:US
Mailing Address - Phone:212-653-8894
Mailing Address - Fax:
Practice Address - Street 1:330 W 58TH ST STE 502
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1819
Practice Address - Country:US
Practice Address - Phone:212-653-8894
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-05
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021654103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty