Provider Demographics
NPI:1164572723
Name:DOWNSTATE ICLC PSYCHOLOGICAL SERVICES, PLLC
Entity Type:Organization
Organization Name:DOWNSTATE ICLC PSYCHOLOGICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HITTELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:718-270-2036
Mailing Address - Street 1:415 E 37TH ST
Mailing Address - Street 2:34A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-3200
Mailing Address - Country:US
Mailing Address - Phone:718-270-2036
Mailing Address - Fax:718-270-3910
Practice Address - Street 1:445 LENOX RD
Practice Address - Street 2:SUITE D
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2017
Practice Address - Country:US
Practice Address - Phone:718-270-2036
Practice Address - Fax:718-270-3910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02800071Medicaid