Provider Demographics
NPI:1508374646
Name:ALLIANCE PSYCHOLOGICAL SERVICES OF NEW YORK, PLLC
Entity Type:Organization
Organization Name:ALLIANCE PSYCHOLOGICAL SERVICES OF NEW YORK, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SOMERVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:718-971-9731
Mailing Address - Street 1:6014 67TH AVE # 1
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-4536
Mailing Address - Country:US
Mailing Address - Phone:718-971-9731
Mailing Address - Fax:718-425-9862
Practice Address - Street 1:6014 67TH AVE # 1
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-4536
Practice Address - Country:US
Practice Address - Phone:718-971-9731
Practice Address - Fax:718-425-9862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-10
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022436103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty