Provider Demographics
NPI:1306408513
Name:NORTHEAST PSYCHOLOGICAL WELLNESS, PLLC
Entity Type:Organization
Organization Name:NORTHEAST PSYCHOLOGICAL WELLNESS, PLLC
Other - Org Name:NORTHEAST THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMOTAR
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:646-450-3064
Mailing Address - Street 1:733 3RD AVE FL 16
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-3224
Mailing Address - Country:US
Mailing Address - Phone:646-450-3064
Mailing Address - Fax:
Practice Address - Street 1:733 3RD AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-3204
Practice Address - Country:US
Practice Address - Phone:646-450-3064
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-08
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty