Provider Demographics
NPI:1588012702
Name:ADELPHI UNIVERSITY
Entity Type:Organization
Organization Name:ADELPHI UNIVERSITY
Other - Org Name:POSTGRADUATE PSYCHOTHERAPY CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:HERSKOVITS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:516-877-4841
Mailing Address - Street 1:158 CAMBRIDGE AVE
Mailing Address - Street 2:325
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-4235
Mailing Address - Country:US
Mailing Address - Phone:516-877-4841
Mailing Address - Fax:
Practice Address - Street 1:158 CAMBRIDGE AVE
Practice Address - Street 2:325
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-4235
Practice Address - Country:US
Practice Address - Phone:516-877-4841
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysisGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty