Provider Demographics
NPI:1477755429
Name:COMMUNITY PSYCHOTHERAPY ASSOCIATES, INC.
Entity Type:Organization
Organization Name:COMMUNITY PSYCHOTHERAPY ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:X
Authorized Official - Last Name:KOWALSKI
Authorized Official - Suffix:
Authorized Official - Credentials:EDS
Authorized Official - Phone:201-339-0142
Mailing Address - Street 1:479 AVENUE C
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-5110
Mailing Address - Country:US
Mailing Address - Phone:201-339-0142
Mailing Address - Fax:201-339-1106
Practice Address - Street 1:479 AVENUE C
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-5110
Practice Address - Country:US
Practice Address - Phone:201-339-0142
Practice Address - Fax:201-339-1106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40940261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJNJ306464OtherDAS CLINIC NUMBER
NJ744841Medicare ID - Type UnspecifiedAGENCY MEDICARE NUMBER