Provider Demographics
NPI:1629354717
Name:BRONXVILLE PSYCHIATRIC WELLNESS GROUP, P.C.
Entity Type:Organization
Organization Name:BRONXVILLE PSYCHIATRIC WELLNESS GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:REHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:LATIF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-337-3253
Mailing Address - Street 1:130 PONDFIELD RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-4015
Mailing Address - Country:US
Mailing Address - Phone:914-337-3253
Mailing Address - Fax:914-337-7013
Practice Address - Street 1:130 PONDFIELD RD
Practice Address - Street 2:SUITE 2
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-4015
Practice Address - Country:US
Practice Address - Phone:914-337-3253
Practice Address - Fax:914-337-7013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty