Provider Demographics
NPI:1164827317
Name:FERNDALE PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:FERNDALE PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:845-292-6222
Mailing Address - Street 1:111 SULLIVAN AVE
Mailing Address - Street 2:SUITE 2-5
Mailing Address - City:FERNDALE
Mailing Address - State:NY
Mailing Address - Zip Code:12734-4315
Mailing Address - Country:US
Mailing Address - Phone:845-292-6222
Mailing Address - Fax:845-292-6220
Practice Address - Street 1:111 SULLIVAN AVE
Practice Address - Street 2:SUITE 2-5
Practice Address - City:FERNDALE
Practice Address - State:NY
Practice Address - Zip Code:12734-4315
Practice Address - Country:US
Practice Address - Phone:845-292-6222
Practice Address - Fax:845-292-6220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-30
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty