Provider Demographics
NPI:1194025445
Name:CONSUMER PSYCHOLOGICAL SERVICES PC
Entity Type:Organization
Organization Name:CONSUMER PSYCHOLOGICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:S
Authorized Official - Last Name:BORAKOVE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:914-714-5023
Mailing Address - Street 1:75 ZUKOR RD
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-5507
Mailing Address - Country:US
Mailing Address - Phone:914-714-5023
Mailing Address - Fax:845-634-0806
Practice Address - Street 1:55 OLD NYACK TPKE
Practice Address - Street 2:SUITE 601
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-2461
Practice Address - Country:US
Practice Address - Phone:914-714-5023
Practice Address - Fax:845-634-0806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011044103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02192671Medicaid
NY873561Medicare PIN