Provider Demographics
NPI:1477294361
Name:CENTER FOR INTEGRATIVE MENTAL HEALTH
Entity Type:Organization
Organization Name:CENTER FOR INTEGRATIVE MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, DSW
Authorized Official - Phone:917-983-2700
Mailing Address - Street 1:200 W 90TH ST APT 2E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-1233
Mailing Address - Country:US
Mailing Address - Phone:917-983-2700
Mailing Address - Fax:
Practice Address - Street 1:200 W 90TH ST APT 2E
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-1233
Practice Address - Country:US
Practice Address - Phone:917-983-2700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty