Provider Demographics
NPI:1558726422
Name:THERAPY WEST
Entity Type:Organization
Organization Name:THERAPY WEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIICAL PSYCHOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:IAN
Authorized Official - Last Name:KASSINOVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-580-0080
Mailing Address - Street 1:124 W 79TH ST
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-6470
Mailing Address - Country:US
Mailing Address - Phone:212-580-0080
Mailing Address - Fax:212-580-0047
Practice Address - Street 1:124 W 79TH ST
Practice Address - Street 2:SUITE 1B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024
Practice Address - Country:US
Practice Address - Phone:212-580-0080
Practice Address - Fax:212-580-0047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-21
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014602103T00000X
NYP99046103T00000X
NY7549075103T00000X
NYP99660103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty