Provider Demographics
NPI:1104356195
Name:QUEENS COGNITIVE BEHAVIORAL THERAPY PSYCHOLOGY, PLLC
Entity Type:Organization
Organization Name:QUEENS COGNITIVE BEHAVIORAL THERAPY PSYCHOLOGY, PLLC
Other - Org Name:QUEENS CBT CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:ZVI
Authorized Official - Last Name:GRYSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:347-815-4228
Mailing Address - Street 1:14108 JEWEL AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-1618
Mailing Address - Country:US
Mailing Address - Phone:347-815-4228
Mailing Address - Fax:347-402-8186
Practice Address - Street 1:14108 JEWEL AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-1618
Practice Address - Country:US
Practice Address - Phone:347-815-4228
Practice Address - Fax:347-402-8186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003047101YM0800X
NY019732103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP5268379OtherUNITED HEALTH CARE OXFORD