Provider Demographics
NPI:1497172449
Name:COGNITIVE BEHAVIORAL SOLUTIONS PSYCHOLOGICAL SERVICES PC
Entity Type:Organization
Organization Name:COGNITIVE BEHAVIORAL SOLUTIONS PSYCHOLOGICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHAIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:718-207-3474
Mailing Address - Street 1:246 BEACH 13TH ST
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-5506
Mailing Address - Country:US
Mailing Address - Phone:718-207-3474
Mailing Address - Fax:
Practice Address - Street 1:246 BEACH 13TH ST
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-5506
Practice Address - Country:US
Practice Address - Phone:718-207-3474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-27
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019727103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100104566Medicare PIN
NYG100148317Medicare PIN