Provider Demographics
NPI:1407421712
Name:HUMPHRIES THIRD, LLC
Entity Type:Organization
Organization Name:HUMPHRIES THIRD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHOSHANA
Authorized Official - Middle Name:D
Authorized Official - Last Name:BERAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:202-253-0408
Mailing Address - Street 1:100 S BEDFORD RD STE 340
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3444
Mailing Address - Country:US
Mailing Address - Phone:914-362-1083
Mailing Address - Fax:
Practice Address - Street 1:100 S BEDFORD RD STE 340
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3444
Practice Address - Country:US
Practice Address - Phone:914-362-1083
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-20
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health