Provider Demographics
NPI:1326716317
Name:PROGRESSIVE BEHAVIORAL PSYCHOLOGY SERVICES NEW YORK PC
Entity Type:Organization
Organization Name:PROGRESSIVE BEHAVIORAL PSYCHOLOGY SERVICES NEW YORK PC
Other - Org Name:AUTISM PARTNERSHIP NEW YORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:IVY
Authorized Official - Middle Name:
Authorized Official - Last Name:DIMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-422-9760
Mailing Address - Street 1:200 MARINA DR
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-6023
Mailing Address - Country:US
Mailing Address - Phone:562-431-9293
Mailing Address - Fax:562-685-0413
Practice Address - Street 1:344 E 59TH ST FL 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1593
Practice Address - Country:US
Practice Address - Phone:562-431-9293
Practice Address - Fax:562-685-0413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-02
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty