Provider Demographics
NPI:1790229433
Name:PSYCHOTHERAPY PRACTICE
Entity Type:Organization
Organization Name:PSYCHOTHERAPY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SHTERNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:415-745-2426
Mailing Address - Street 1:836 EASTERN PKWY APT 1B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-3515
Mailing Address - Country:US
Mailing Address - Phone:415-745-2426
Mailing Address - Fax:
Practice Address - Street 1:836 EASTERN PKWY APT 1B
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-3515
Practice Address - Country:US
Practice Address - Phone:415-745-2426
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-15
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001331305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service