Provider Demographics
NPI:1104202027
Name:EAST VILLAGE CREATIVE PSYCHOLOGY
Entity Type:Organization
Organization Name:EAST VILLAGE CREATIVE PSYCHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:J
Authorized Official - Last Name:DURANT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:917-677-5740
Mailing Address - Street 1:245 E 13TH ST
Mailing Address - Street 2:GROUND FLOOR SUITE #4
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-5641
Mailing Address - Country:US
Mailing Address - Phone:917-677-5740
Mailing Address - Fax:
Practice Address - Street 1:245 E 13TH ST
Practice Address - Street 2:GROUND FLOOR SUITE #4
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-5641
Practice Address - Country:US
Practice Address - Phone:917-677-5740
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019704103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty