Provider Demographics
NPI:1790911865
Name:SOUTHFIELD CENTER FOR PSYCHOLOGICAL SERVICES, LLC
Entity Type:Organization
Organization Name:SOUTHFIELD CENTER FOR PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:M
Authorized Official - Last Name:BOGART
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:203-348-9920
Mailing Address - Street 1:68 SOUTHFIELD AVE
Mailing Address - Street 2:TWO STAMFORD LANDING-SUITE 160
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-7237
Mailing Address - Country:US
Mailing Address - Phone:203-348-9920
Mailing Address - Fax:
Practice Address - Street 1:68 SOUTHFIELD AVE
Practice Address - Street 2:TWO STAMFORD LANDING-SUITE 160
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-7237
Practice Address - Country:US
Practice Address - Phone:203-348-9920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty