Provider Demographics
NPI:1790542405
Name:BRONX RIVER ROAD LICENSED CLINICAL SOCIAL WORK PLLC
Entity Type:Organization
Organization Name:BRONX RIVER ROAD LICENSED CLINICAL SOCIAL WORK PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:MAX
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:GUTTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-452-0493
Mailing Address - Street 1:941 MCLEAN AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-4107
Mailing Address - Country:US
Mailing Address - Phone:914-452-0493
Mailing Address - Fax:
Practice Address - Street 1:411 BRONX RIVER RD APT 3E
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10704-3429
Practice Address - Country:US
Practice Address - Phone:914-452-0493
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty