Provider Demographics
NPI:1568904639
Name:NY WELLNESS PSYCHOLOGY PC
Entity Type:Organization
Organization Name:NY WELLNESS PSYCHOLOGY PC
Other - Org Name:SHIBANI RAY-MAZUMDER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIBANI
Authorized Official - Middle Name:
Authorized Official - Last Name:RAY-MAZUMDER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, SCD
Authorized Official - Phone:631-786-9312
Mailing Address - Street 1:466 W 153RD ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-1101
Mailing Address - Country:US
Mailing Address - Phone:631-786-9312
Mailing Address - Fax:
Practice Address - Street 1:250 E 30TH ST APT 9A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-8298
Practice Address - Country:US
Practice Address - Phone:631-786-9312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-07
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020691-1103TH0004X
NY02069-1251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealthGroup - Single Specialty