Provider Demographics
NPI:1235570706
Name:WEST SIDE PSYCHOTHERAPY, LCSW, P.C.
Entity Type:Organization
Organization Name:WEST SIDE PSYCHOTHERAPY, LCSW, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT/THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:646-250-3182
Mailing Address - Street 1:201 W 94TH ST
Mailing Address - Street 2:3A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6938
Mailing Address - Country:US
Mailing Address - Phone:646-350-3182
Mailing Address - Fax:
Practice Address - Street 1:350 CENTRAL PARK W
Practice Address - Street 2:SUITE 1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6547
Practice Address - Country:US
Practice Address - Phone:646-250-3182
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-12
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054990-1251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health