Provider Demographics
NPI:1740564905
Name:VALLEY PSYCHOLOGICAL, PC
Entity Type:Organization
Organization Name:VALLEY PSYCHOLOGICAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:BERNARD
Authorized Official - Last Name:KOGEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:914-419-0088
Mailing Address - Street 1:169 STERLING ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-3416
Mailing Address - Country:US
Mailing Address - Phone:914-419-0088
Mailing Address - Fax:
Practice Address - Street 1:169 STERLING ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-3416
Practice Address - Country:US
Practice Address - Phone:914-419-0088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-06
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003552103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty