Provider Demographics
NPI:1689692840
Name:ADVANCED CENTER FOR PSYCHOTHERAPY
Entity Type:Organization
Organization Name:ADVANCED CENTER FOR PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:HUTTERER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:718-261-3330
Mailing Address - Street 1:46 SCHENCK AVENUE
Mailing Address - Street 2:#3P
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021
Mailing Address - Country:US
Mailing Address - Phone:516-487-7812
Mailing Address - Fax:
Practice Address - Street 1:103 26 68TH ROAD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375
Practice Address - Country:US
Practice Address - Phone:718-261-3330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070067251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYO70067Medicare ID - Type UnspecifiedSOCIAL WORK