Provider Demographics
NPI:1609935444
Name:ADULT CARE PSYCHOLOGY SERVICES, PLLC
Entity Type:Organization
Organization Name:ADULT CARE PSYCHOLOGY SERVICES, PLLC
Other - Org Name:ADULT CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:KUTNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:718-575-3510
Mailing Address - Street 1:13711 73RD TER
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-2303
Mailing Address - Country:US
Mailing Address - Phone:718-575-3510
Mailing Address - Fax:718-575-0391
Practice Address - Street 1:13711 73RD TER
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-2303
Practice Address - Country:US
Practice Address - Phone:718-575-3510
Practice Address - Fax:718-575-0391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-07
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02164212Medicaid
000409099OtherUNITED BEHAVIORAL HEALTH
678886OtherVALUE OPTIONS
403672OtherEMBLEM HEALTH
NY7379731OtherAETNA
NY814181000OtherMAGELLAN
678886OtherVALUE OPTIONS
NYV5W581Medicare ID - Type UnspecifiedEMPIRE