Provider Demographics
NPI:1265833404
Name:SR PSYCHOLOGICAL SERVICES P.C.
Entity Type:Organization
Organization Name:SR PSYCHOLOGICAL SERVICES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHATIECE
Authorized Official - Middle Name:
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:646-359-6685
Mailing Address - Street 1:303 5TH AVE
Mailing Address - Street 2:STE 1213
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6693
Mailing Address - Country:US
Mailing Address - Phone:646-359-6685
Mailing Address - Fax:646-922-7263
Practice Address - Street 1:303 5TH AVE
Practice Address - Street 2:STE 1213
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6693
Practice Address - Country:US
Practice Address - Phone:646-359-6685
Practice Address - Fax:646-922-7263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016729103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty