Provider Demographics
NPI:1477536464
Name:PARK AVENUE PSYCHOTHERAPY
Entity Type:Organization
Organization Name:PARK AVENUE PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO DIRECTOR PSYCHOTHERAPY
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHAN
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:MSW PHD
Authorized Official - Phone:718-634-0253
Mailing Address - Street 1:167 E 135TH ST
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11694
Mailing Address - Country:US
Mailing Address - Phone:718-634-0253
Mailing Address - Fax:
Practice Address - Street 1:167 E 135TH ST
Practice Address - Street 2:
Practice Address - City:ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11694
Practice Address - Country:US
Practice Address - Phone:718-634-0253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty